genitourinary disorders
Medical Aspects of Long Term Renal Replacement Therapy
Aluminum toxicity
Toxicity is a risk in hemodialysis patients who are exposed to aluminum-contaminated dialysate (now uncommon) and aluminum-based phosphate binders. Manifestations are osteomalacia, microcytic anemia (iron-resistant), and probably dialysis dementia (a constellation of memory loss, dyspraxia, hallucinations, facial grimaces, myoclonus, seizures, and a characteristic electroencephalogram [EEG]). Aluminum toxicity should be considered in patients receiving RRT who develop osteomalacia, iron-resistant microcytic anemia, or neurologic manifestations such as memory loss, dyspraxia, hallucinations, facial grimaces, myoclonus, or seizures. Diagnosis is by measurement of plasma aluminum before and 2 days after IV infusion ofdeferoxamine5 mg/kg.Deferoxaminechelates aluminum, releasing it from tissues and increasing the blood level among patients with aluminum toxicity. A rise in aluminum level of≥50 mcg/L suggests toxicity. Aluminum-related osteomalacia can also be diagnosed by needle biopsy of bone (requires special stains for aluminum). Treatment is avoidance of aluminum-based binders plus IV or intraperitonealdeferoxamine. Consider aluminum toxicity in RRT patients with osteomalacia, iron-resistant microcytic anemia, or neurologic symptoms. 