ALUMINUM SPECIATION IN CEREBROSPINAL-FLUID OF ACUTELY ALUMINUM-INTOXICATED DIALYSIS PATIENTS BEFORE AND AFTER DESFERRIOXAMINE TREATMENT - ASTEP IN THE UNDERSTANDING OF THE ELEMENTS NEUROTOXICITY

Background. The association between aluminium and dialysis encephalopa thy and deterioration of the neurological state during desferrioxamine treatment of dialysis patients is well established. At present little is known about the speciation and the mechanisms underlying the eleme nt's neurotoxicity. Methods. Aluminium speciation was performed in cer ebrospinal fluid samples of acutely aluminium-intoxicated dialysis pat ients using a recently developed high-performance liquid chromatograph ic/electrothermal atomic absorption spectrometric hybrid method. Resul ts. Baseline cerebrospinal fluid aluminium levels of samples taken sho rtly after the intoxication were low but elevated (5.0 +/- 2.0 mu g/l, n=3) as compared to subjects with normal renal function (<1 mu g/l). In contrast to the situation noted in serum and to the iron speciation in cerebrospinal fluid, aluminium was not bound to transferrin but ap peared as two distinct compounds, the main fraction eluting at the elu tion volume of aluminium-citrate/silicate. The second compound was not identified. Forty-four hours after desferrioxamine administration the cerebrospinal fluid aluminium levels had increased up to a concentrat ion of 10.3+/-2.5 mu g/l (n=3). This was accompanied by a change in th e speciation profile with aluminium appearing at the elution volume of aluminoxamine. Conclusions. Our findings may contribute to a better u nderstanding of the neurotoxic effects of aluminium and its desferriox amine chelate in dialysis patients.