Aluminium Toxicity in Renal Failure

Abstract

There is now no doubt that aluminium contamination of water supplies used for the preparation of dialysis fluid can lead to encephalopathy, vitamin D resistant fracturing osteomalacia and microcytic anaemia in patients receiving haemodialysis. Although the introduction of adequate water treatment to remove aluminium has effectively stopped the epidemics of these diseases which made them the major cause of death in some dialysis units in the 1970’s, sporadic occurrences of identical syndromes have also been described in patients who have never received dialysis, have been trated exclusively with peritoneal dialysis or have received haemodialysis using water known to have a very low aluminium content. In these patients other sources of aluminium have been implicated, the oral administration of aluminium salts used as phosphate-binding agents and contamination of parenteral fluids being the culprits. The rate of aluminium accummulation, which has marked effects on the distribution within the body, has been slower with oral administration. Thus, a new pattern of aluminium-related disease with a different epidemiology is emerging in patients with renal failure. This has ensured that the prevention, detection and treatment of aluminium toxicity will continue to be an important part of nephrological practice for many years.