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Assessing the utility of testing aluminum levels in dialysis patients
Author(s) -
Sharma Ashish K.,
Toussaint Nigel D.,
Pickering Janice,
Beeston Tony,
Smith Edward R.,
Holt Stephen G.
Publication year - 2015
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12231
Subject(s) - medicine , dialysis , toxicity , hemodialysis , odds ratio , surgery , gastroenterology
Plasma aluminum ( A l) is routinely tested in many dialysis patients. A luminum exposure may lead to acute toxicity and levels in excess of ∼2.2 μmol/L (60 μg/L) should be avoided. Historically, toxicity has been caused by excessive dialyzate A l but modern reverse osmosis ( RO ) water should be A l free. Nevertheless, many units continue to perform routine A l levels on dialysis patients. This single‐center study retrospectively analyzed A l levels in plasma, raw water feed, and RO product between 2010 and 2013 using our database ( N ephworks 6) with the aim of determining the utility of these measurements. Two thousand fifty‐eight plasma A l tests in 755 patients (61.9% male, mean age 64.7 years) were reviewed showing mean ± SD of 0.41 ± 0.30 μmol/L. One hundred eleven (5.4%) tests from 61 patients had A l levels >0.74 μmol/L and 45 (73.8%) of these patients were or had been prescribed A l hydroxide ( Al(OH) 3 ) as a phosphate binder. Seven patients had A l concentrations >2.2 μmol/L with no source of A l identified in 1 patient. One hundred sixty‐six patients taking Al(OH) 3 (78.7% of all patients on Al(OH) 3 ) had levels ≤0.74 μmol/L, the odds ratio of plasma A l > 0.74 μmol/L on Al(OH) 3 was 9. The cost of plasma A l assay is $ A 30.60; thus, costs were $ A 62,974.80 over the study period. Despite RO feed water A l levels as high as 48 μmol/L, A l output from the RO was almost always undetectable (<0.1 μmol/L) with dialyzate A l levels > 2.2 μmol/L only 3 times since 2010, and never in the last 3 years. Routine unselected testing of plasma A l appears unnecessary and expensive and more selective testing in dialysis patients should be considered.