EFFECT OF CITRATE ON SERUM ALUMINUM CONCENTRATIONS IN HEMODIALYSIS-PATIENTS - A PROSPECTIVE-STUDY

Twenty hemodialysis patients were prospectively evaluated to determine if concomitant citrate and aluminum administration enhances the absor ption of aluminum, thereby increasing the possibility of toxicity. The four-phase study consisted of phase I, a washout phase; phase II, an aluminum treatment phase; phase III, a treatment phase combining alumi nium and soluble calcium citrate; and phase IV, a treatment phase with the patient's original prestudy phosphate binder. Results disclosed a progressive rise in serum aluminum levels (mu g/L) from 47 +/- 8 (pha se I) to 62 +/- 12 (phase II) to 74 +/- 13 (phase III) and a drop to 5 8 +/- 12 (phase IV). The difference in levels between phases I and III was significant. Additionally, and despite the fact that serum calciu m concentrations did not change, serum phosphate and immunoreactive pa rathyroid hormone concentrations were significantly lower when aluminu m and citrate were used together. This suggests that citrate enhances the absorption of aluminum and therefore increases the possibility of toxicity in the patient with end-stage renal disease.