Evaluation of serum aluminum level before and after (DFO) test in patients of hemodialysis unit of Zahedan

Background: Aluminum accumulation in plasma and tissues is a well-described complication
among persons undergoing peritoneal dialysis or hemodialysis. Excess bone aluminum is
associated with low bone formation rates and increased risk for fractures. Current
recommendations for care of patients with end-stage renal disease include screening for aluminum
toxicity with plasma aluminum levels; patients with levels below20 micro g/L are considered to be
at low risk for aluminum related bone disease (ARBD). By attention to some clinical symptoms that
maybe related to AL toxicity, we measured serum AL level before and after DFO test.
Methods and materials: In this descriptive study the incidence of AL toxicity in patients on
hemodialysis in Khatam-Al-Anbia hospital of Zahedan-Iran was measured. In 35 patients on
hemodialysis, serum level of AL before and after DFO test was measured. We also measured serum
level of Ca, P, ALP, PTH and Ferritin in these groups of patients. To evaluate AL level in water
used for hemodialysis it was measured at the same time.
Results: In our study serum AL levels in most of patients were high (32 out of 35). It maybe
due to high level of AL in dialysate. Dialysate AL level before and after RO (Reverse Osmosis) were
16 microgram/Lit and 19.8 microgram/Lit respectively. In only 3 out of 35 patient’s serum AL
levels of baseline were less than 20 microgram/Lit and DFO test in one of them was positive.
Serums AL level of 16 patients were between 20 to 40 microgram / Lit and in 16 patients were more
than 40 microgram/Lit.
Conclusions: In conclusion treatment with improperly processed water was the major causes of
aluminum toxicity in uremic patients.