EFFECT OF LONG-TERM LOW-DOSE ALUMINUM-CONTAINING AGENTS ON HEMOGLOBIN-SYNTHESIS IN PATIENTS WITH CHRONIC RENAL-INSUFFICIENCY

To investigate the possible toxic effects of long-term low-dose exposu re to Al-containing agents in 55 patients with chronic renal insuffici ency (CRI), 37 patients received Al(OH)(3) 1 tablet 3 times per day (a bout 302 mg/day of elemental Al) for 3 months and another 18 were used as a control group. The hematological, iron status and Al data were m easured before and after the study. CRI patients who had ingested Al-c ontaining agents for 3 months had significant decreases in hematologic al parameters and increases in serum Al and daily urinary Al excretion . Serum ferritin negatively correlated with serum Al (r = -0.586, p < 0.0005), and hemoglobin (Hb) positively correlated with renal Al clear ance (r = 0.573, p < 0.0005) and logarithmic transformation of serum A l (r = -0.437, p < 0.01) in these patients, despite no significant cor relations between initially basal hematological and Al parameters. But there were no significant differences between variables of Al and hem atological parameters before and after 3 months of follow-up in the co ntrol group. All factors correlating with Hb were measured with stepwi se regression analysis; renal Al clearance, creatinine clearance (C-cr ) and serum iron were the most significant correlation factors with Hb . After C-cr and serum iron had been adjusted, Hb (b = 0.069 +/- 0.02; p < 0.05) still positively correlated with renal Al clearance. Compar ing patients who had reduced Hb (at least 0.5 g/dl) and those who did not, the response group had a lower basal (C-cr a higher serum Al and a lower renal Al clearance after Al loading for 3 months. In conclusio n, Al does play a role in the significant reduction of Hb and hematocr it in CRI patients after Al loading for 3 months, and patients with a lower C-cr may easily develop Al-induced hematologically toxic effects . Al-containing agents should be used with care in long-term therapies of CRI patients.