Aluminum exposure in chronic renal failure in Iberoamerica at the end of the 1990s: Overview and perspectives

Epidemic aluminum neurotoxicity has virtually disappeared in the dialysis p opulation; however, sporadic toxic effects caused by contamination of water with aluminum are still reported. In this review, the current situation in Iberoamerica is analyzed. Exposure to aluminum through dialysate shows con siderable geographical differences even within the same country, including seasonal variability. Sometimes the tap water showed very high aluminum con tent that does not permit the water treatment system to efficiently remove ail the aluminum, forcing the use of water treatment systems with a double reverse-osmosis filter on line. The use of adequate water treatment systems and a correct control policy has improved the quality of the dialysate, mi nimizing the aluminum exposure. However, an additional problem in Iberoamer ica is the difficulty to obtain aluminum-free concentrates for the preparat ion of the final dialysis solution. Aluminum sti seems to be implicated in a great percentage of symptomatic low-bone remodeling lesions in South Amer ica compared with Europe, demonstrating that exposure to aluminum through d ialysate is still a cause of concern in some areas of the world.