EPIDEMIC ALUMINUM INTOXICATION IN HEMODIALYSIS-PATIENTS TRACED TO USEOF AN ALUMINUM PUMP

This study was designed to identify the source, risk factors, and clin ical consequences of an outbreak of aluminum intoxication in hemodialy sis patients using case-control and cohort studies. In 1991, a dialysi s center in Pennsylvania [Dialysis Center A (DCA)] identified a number of patients with elevated serum aluminum levels. All patients receivi ng dialysis at DCA during January 1, 1987 to March 26, 1992 were invol ved in the study. A case-patient was defined as any patient with a ser um aluminum level greater than or equal to 100 mu g/liter after greate r than or equal to 5 dialysis sessions at DCA. Fifty-nine case-patient s were identified. Risk factors for elevated serum aluminum levels wer e receipt of bicarbonate- (rather than acetate-) based dialysate, high er number of sessions using bicarbonate dialysis, receipt of acid conc entrate (used in bicarbonate dialysis) passed through one of two elect ric pumps, and a greater number of sessions using this concentrate. Th e electric pumps had an aluminum casing, casing cover, and impeller. E levated levels of aluminum were found in acid concentrate after passin g through a pump. Seizures and mental status changes requiring hospita lization were associated with aluminum exposure. We found that epidemi c aluminum intoxication was caused by the use of an electric pump with aluminum housing to deliver acid concentrate used in bicarbonate dial ysis. This outbreak demonstrates why it is essential to insure that al l fluid pathways, storage tanks, central delivery systems, and pumps a re compatible with low pH fluids before converting from acetate to bic arbonate dialysis.