ABSTRACT
Gastrointestinal aluminium (A1) absorption has been proved but its mechanism is still unknown. This study investigates the pattern of A1 absorption in patients with different degrees of iron stores. We studied 29 haemodialysis patients forming three groups according to their serum ferritin values. Over seven days all patients received the same dose of aluminium hydroxide after which patients with 'low-normal' and normal serum ferritin increased their serum A1 proportionally with the increased aluminium hydroxide intake. By contrast patients with high serum ferritin did not show any change in their serum A1 values. Our results therefore suggest that a 'common pathway' of metal absorption could be implicated in A1 absorption. Serum ferritin might be a valuable predictor of different behaviour.
Subject(s)
Aluminum/metabolism , Renal Dialysis/adverse effects , Adult , Aged , Aluminum/adverse effects , Ferritins/metabolism , Humans , Intestinal Absorption , Iron/metabolism , Middle AgedABSTRACT
Convincing evidence exists concerning aluminium hydroxide (A1 (OH)3) absorption and risk of toxicity. Over recent years our aim has been to reduce exposure to this risk. In this study we evaluated the effect of changing our A1 (OH)3 prescription policy, reducing its intake by stopping the breakfast dose, separating the iron intake from the binder's influence, and tailoring the A1 (OH)3 dose according to the protein intake patterns. The change was done gradually, initially in a pilot group and then in the whole unit. The results from the pilot group, who completed two years follow-up and from the whole unit, when more patients adhered to the new scheme, were similar. After the A1 (OH)3 reduction serum phosphorus did not change, haemoglobin increased and the blood transfusion requirements decreased. These results support our preliminary findings that A1 (OH)3 might interfere with erythropoiesis and stress the necessity of reassessing the prescription of binders thoroughly aiming to give adequate individual doses according to the different protein intake patterns.