ALUMINUM-RELATED BONE-DISEASE IN CHRONIC- HEMODIALYSIS PATIENTS

Plasma aluminum (pAl) was measured in 58 patients coming from three ce nters using different preparation of dialysis water deionizer (29 pati ents). softener (16 patients) and reverse osmosis (13 patients) Twenty five healthy subjects were used as controls. A deferoxamine test was performed to 11 of 19 patients with pAl between 40 and 200 ug/dl and a bone biopsy with double tetracycline staining was executed to 15 pati ents with pAl over 40 ug/dl Mean pAl was 9.5 +/- 1.7 ug/dl in controls and 34.3 +/- 6.1 169 +/- 27.8 and 50.8 +/- 10.3 ug/dl in patients com ing form centers using deionizers, softeners and reverse osmosis respe ctively Seventy six percent of patients coming from centers using deio nizers and 85% of patients coming from centers with reverse osmosis ha d pAl below 40 ug/dl and all had values below 200 ug/dl. Plasma alumin um had a increase of over 200 ug/dl in 6 of 11 patients in which the d eferoxamine test was performed. Six patients had a positive staining f or aluminum in bone biopsies (three with basal pAl over 200 ug/dl and one with a increase in pAL after deferoxamine < 200 ug/dl). Of these, 2 patients had a mixed osteodystrophy and 4 a low turnover bone diseas e. Centers with deionizers and reverse osmosis had very low aluminum l evels in dialysis water and five of six patients with aluminum levels related bone disease came from the center using softener.