Hepatitis B vaccination: Another parenteral source of aluminum loading in hemodialysis patients

During the six month period november 1996 to april 1997 we observed that ep isodic increases in serum aluminum levels, suggesting aluminum overload, oc curred in some patients on regular hemodialysis (HD). The aluminum content of dialysis fluid never exceeded 3 mu g/l and nobody had been treated with intravenous albumin or oral sucralfate. There had been no changes in dialys is membrane. Not all of the patients were taking aluminum hydroxide as phos phate binder Therefore we studied the effect of vaccination on serum alumin um. From may to december 1997, in a prospective study on 17 HD patients, we mea sured serum aluminum levels on days 0, 2, 7 and 30 after a single dose (40 mu g) of Engerix B(R) (total number of doses administered: 34). Serum alumi num was measured in 16 non-vaccinated patients at the same time intervals. The average serum aluminum levels (mu g/l) across the 34 doses studied were : pre-vaccination: 24.1 +/- 10.9, 2 days: 30.1 +/- 14.4, 7 days 46.8 +/- 29 .01 and 30 days post-vaccination: 25.7 +/- 8.6. Serum aluminum levels 2 day s after vaccination were higher than pre-vaccination levels (p < 0.07) and 30 days post-vaccinaton levels (p < 0.027). Serum aluminum levels 7 days al ter vaccination were higher than pre-vaccination levels (p < 0.007), 2 days levels (p < 0.008) and 30 days post-vaccination levels (p < 0,05). There w ere no differences between prevaccination levels and 30 days post-vaccinati on levels. The average of serum aluminum levels in the non-vaccinated patients were 27 .8 +/- 13.7 mu g/l and there were no differences between 0, 2, 7 and 30 day s. In conclusion, hepatitis B vaccination (Engerix B(R)) is another parenteral loading source of aluminum in patients that needs bo be acknowledged to pr event confusion. Thus, we recommend screening for serum aluminum levels at least up to 30 days after vaccination.