[Accumulation of aluminum in the dialyzed patient: incidence, causes and possibilities of prevention].

In a group of 60 patients dialyzed for more than three years laboratory signs of aluminum accumulation were found in 30%. Serum Al values correlated with the increment in the desferal test. Orally administered aluminium hydroxide is a significant source of Al accumulation, as has been demonstrated by the decline of the blood aluminium level after its discontinuation and a negative desferal test in patients to whom it was not prescribed. The passage of Al across the dialyzation membrane depends on the difference between the ultrafiltrable ratio of the blood value and the Al concentration in the dialyzate. Therefore even a concentration of 10 micrograms/l Al in the dilyzate, so far recommended as "safe", can lead to a rise of the Al blood level during haemodialysis and to Al accumulation in tissues. Effective removal of Al from the organism is possible only during haemodialysis after previous administration of Desferal. Unless an adequate substitute of aluminium hydroxide will be available and a completely aluminium free dialyzate, Al accumulation can be prevented by preventive administration of Desferal.