PREVENTION OF ALUMINUM EXPOSURE THROUGH DIALYSIS FLUIDS - ANALYSIS OFCHANGES IN THE LAST 8 YEARS

Despite extensive measures to control aluminium exposure, chronic and acute episodes of aluminium intoxication still occur. The objective of this study was to analyse the changes in the aluminium content of dia lysis fluid and the effect on serum aluminium in different dialysis ce ntres in Spain in the last 8 years. For this purpose, the aluminium co ntent in dialysis fluid and serum samples (N = 5609) from 17 dialysis centres was analysed for >8 years (from the last quarter of 1988 to 19 96). In that period of time, the percentage of dialysis fluid samples with acceptable concentrations of aluminium (<2 mu g/l) increased from 0% in 1988 to 80% in 1996. The percentage of dialysis fluid samples w ith high aluminium levels (>6 mu g/l) ranged between 37.5% in 1988 and 2.3% in 1996. The improvement in the quality of the dialysis fluid re sulted in lower values of serum aluminium. The percentage of serum sam ples with low aluminium (<20 mu g/l) increased from 16.5% in 1988 to 5 4.2% in 1966. The mean serum aluminium correlated with the mean dialys is fluid aluminium (r=0.55, P<0.001). A higher correlation was found w hen the aluminium in dialysis fluid ranged between 4 and 10 mu g/l (r= 0.802, P<0.001), and no correlation was found when the aluminium in di alysis fluid was <4 mu g/l. Even taking into account that the dialysis fluid is not the only source of aluminium for dialysis patients, our study clearly demonstrated a close relationship with the serum alumini um content. Therefore, we must emphasize the necessity for controlling the aluminium content in dialysis fluid more often than is done at pr esent.