THE DIALYSIS FLUIDS AS A SOURCE OF ALUMINUM IN HEMODIALYSIS - INFLUENCE IN SERUM ALUMINUM LEVELS

Although there are many sources oi aluminium exposure in dialysis pati ents, the high aluminium levels in dialysis fluids due to fails in the treatment of water still remains the most dangerous source of alumini um contamination. The aim oi this study was 1) to evaluate in a single point in time in 1990 (160 centers) and 1994 (205 centers) the concen tration of aluminium in dialysis fluids and 2) to evaluate throughout the 5 years the concentration of aluminium in dialysis fluids and seru m in 12 dialysis units. The studied units sent regularly throughout 5 years 4466 samples of serum, untreated water (reverse osmosis) and the final solution of dialysis (treated water + concentrate). 1) In 1990 the mean aluminium concentration was 80 +/- 64 mu g/l in untreated wat er, 7.4 +/- 18 mu g/l in treated water and 7.7 +2.1 mu g/l in the fina l solution for dialysis, 28.9% of the aluminium concentration in the f inal solution for dialysis between 4 and 200 mu g/l. In 1994 we observ ed a reduction in the concentration of aluminium in dialysis fluids (2 .7 +/- 6.4 mu g/l) and only 14.1% the participating centres had alumin ium concentrations above 4 mu g/l. 2) In the follow up through 5 years we found the serum aluminium concentration decreased from 1988 to 199 3 parallel to the reduction in the concentration of aluminium in dialy sis fluids. The mean serum aluminium achieved in 1992 was 39.1 mu g/l and the mean value of aluminium in dialysis fluids was 1.1 mu g/l. In 1993 the concentration of aluminium in dialysis fluids increased to a mean value of 3.2 +/- 6.8 mu g/l. This small increment in dialysis flu ids was enough to induce increments in serum aluminium levels. These r esults confirm the fact that the aluminium concentration in dialysis f luids must be maintained under 4 mu g/l, if the fluids exceed this lim it, there is a real risk of aluminium transfer from the fluid to the p atient. Therefore, a frequent and rigorous water and fluids monitoring is mandatory to prevent aluminium exposure through dial) sis fluids.