Influence of Aluminium on the Effect of 1α (OH) D₃ on Renal Osteodystrophy

Abstract

The influence of aluminium in dialysate on the effects of 1α(OH)₃ on hemodialyzed hypocalcemic patients with end-stage renal failure, was studied during a 24- to 42-month period. 51 hypocalcemic patients were divided into two groups; group 1 consisted of 28 patients who were dialyzed using dialysate prepared from reverse osmosed water; the 23 patients in group 2 used dialysate prepared from softened water. Aluminium concentration in the dialysate used for group 1 was less than the detectable limit (10 µg/l) in twelve times determinations, while that for group 2 was 23.1 ± 9.2 µg/l (mean ± SD, n = 14). By the administration of 1α(OH)D₃, the serum concentration of calcium was increased, and that of iPTH and alkaline phosphatase activity was decreased in both groups. Subperiosteal resorption of the finger bone, evaluated by Jensen’s criteria, was significantly improved in group 1, while there was no improvement in group 2. Serum aluminium concentration in the patients of group 1 and group 2 were 46.6 ± 6.3 and 84.7 ± 13.9 µg/l, respectively, and the concentration of the latter was significantly higher than that of the former (p < 0.01). It was also shown that there is a positive correlation between the extent of subperiosteal resorption and the concentration of aluminium in serum. Serum aluminium concentration and bone aluminium content were increased according to the duration of hemodialysis in the patients who were dialyzed using dialysate from softened water, while there was no correlation between the duration of hemodialysis and serum aluminium concentration for the patients of group 1. After changing the supply of water for dialysate, prepared from softened water to reverse osmosed water, serum aluminium concentration significantly decreased. These results are consistent with, but do not prove, the hypothesis that aluminium plays a pathological role in renal osteodystrophy.

Comparison of 1α-OH-Vitamin D₃ and High Doses of Calcium Carbonate for the Control of Hyperparathyroidism and Hyperaluminemia in Patients on Maintenance Dialysis

“…Thus, la-O H D , treatment maintained relatively high plasma concentrations of aluminium (2.6±0.7 um ol/l), concentrations which are not usually associated with overt encephalopathy or osteomalacia but which may interfere with bone remodelling since Shimada et al [26] have shown that la-OH D, was more effective in curing subperiosteal resorption in patients with a plasma alumi nium of 1.7 [i.mol/1 than in patients with a plasma alumi nium of 3.1 pm ol/l, the differences of plasma aluminium in this study being explained by the concentration of aluminium in the dialysate. It is interesting to note that the plasma concentrations of aluminium of their group treated with low aluminium dialysate were however sign ificantly higher than in our patients treated with high calcium carbonate alone, the reason being that they were receiving la-O H D , and Al(OH),.…”