Aluminum accumulation during treatment with aluminum hydroxide and dialysis in children and young adults with chronic renal disease

Article Abstract:

Patients with chronic kidney disease who undergo dialysis (filtering of body fluids to remove waste products from the blood) are at risk for developing abnormally high blood levels of phosphate (hyperphosphatemia). To prevent this, agents that bind phosphate are often administered. However, some of these agents also contain aluminum hydroxide, which can cause aluminum toxicity, related bone abnormalities, and other changes. In recent years, the recommended aluminum doses have been lowered. To determine the effects of these lower aluminum levels, 17 patients were randomly-assigned to receive either aluminum hydroxide or calcium carbonate (an agent substituted for aluminum hydroxide in some cases). The patients ranged in age from 3 to 21 years and were studied for one year. Their diets were monitored and blood was sampled at regular intervals to measure the levels of calcium, phosphorus, and aluminum. In addition, bone biopsies and other bone studies were performed to determine the concentrations of aluminum and other minerals in these tissues, which are critical for the formation of healthy bone. Results showed that treatment with recommended doses of aluminum hydroxide for one year led to increased levels of aluminum in the blood. One patient, of seven in the group that received aluminum hydroxide, developed aluminum-related bone disease. The patients also developed persistent hyperphosphatemia, indicating that the treatment was not effective in controlling the phosphate levels. Six of the seven patients had persistent or progressive renal osteodystrophy (bone abnormalities) of the type commonly associated with secondary hyperparathyroidism (increased secretion of parathyroid hormone, which is common in these patients). This condition had been present in all patients at the beginning of the study, but it improved in 7 of the 10 patients in the calcium carbonate group. It is concluded that calcium carbonate appears to be more effective and safer than aluminum hydroxide for children and young adults undergoing dialysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Measurement, Causes of, Complications and side effects, Physiological aspects, Dialysis, Dialysis (Chemical process), Calcium carbonate, Aluminum in the body, Aluminum (Nutrient), Aluminum hydroxide

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Dialysis therapy

Article Abstract:

Greater advances are needed in dialysis therapy to reduce the high mortality rates of people with end-stage renal disease (ESRD). ESRD is typically caused by diabetes or chronic hypertension. Dialysis is needed because the kidneys can no longer filter waste products from the blood. Dialysis passes the patient's blood past a filter that removes waste products. The patient must have a catheter or a fistula in place so blood can be removed easily. Patients who receive hemodialysis must go to a dialysis center but patients who receive peritoneal dialysis can perform some self-care measures at home.

Analysis, Hemodialysis, Peritoneal dialysis

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Renal transplantation in black Americans

Article Abstract:

The treatment of African-Americans with end-stage kidney disease is reviewed. African-Americans are more likely than whites to develop kidney disease but less likely to receive a kidney transplant.

African Americans, Kidneys, Kidney transplantation

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