Role of medication in the level of aluminium in the blood of chronic haemodialysis patients

• Published in: Nephrology, dialysis, transplantation Vol. 24; no. 4; pp. 1277 - 1281
• Main Authors: Bohrer, Denise, Bertagnolli, Denise C., de Oliveira, Sandra M. R., do Nascimento, Paulo C., de Carvalho, Leandro M., Garcia, Solange C., Arantes, Luiz C., Barros, Elvino J. G.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2009; Oxford Publishing Limited (England)
• Subjects: aluminium; Aluminum - blood; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Drug Contamination; Drug-Related Side Effects and Adverse Reactions; elevated serum aluminium; Emergency and intensive care: renal failure. Dialysis management; erythropoietin; Humans; insulin; Intensive care medicine; iron; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - therapy; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal Dialysis; Renal failure; aluminium; elevated serum aluminium; iron; insulin; erythropoietin; Kidney disease; Human; Urinary system disease; Erythropoietin; Hemodialysis; Aluminium; Iron; Insulin; Extrarenal dialysis; Chemotherapy; Treatment; Polypeptide; Renal failure
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfn631

Background. Although dialysis facilities provide high-quality water, abnormal aluminium levels among patients on haemodialysis have still been reported. Since patients with chronic kidney disease are often on multiple medications, medicines may be an extra source of aluminium for them. The degree to which ingesting contaminated medication influenced the level of aluminium in the patients’ blood was investigated. Methods. All medications consumed by a group of patients on regular dialysis treatment were analysed and the total aluminium ingested by each patient was calculated. At the same time, the patients’ blood was collected and aluminium was measured. The analyses were carried out by atomic absorption spectrometry. Results. For all drugs consumed, the amount of aluminium ingested versus the blood aluminium level presented no correlation. Since a high level of contamination was presented by injectable iron, insulin and erythropoietin (EPO), another group of patients that received a reduced amount of oral medication was selected. Among them, eight did not receive any injectable drug, five received only EPO and seven injectable iron, EPO and insulin. With these restricted groups, it was possible to show that the injectable administration of contaminated medication increased the Al level in the patients’ blood, mainly in relation to iron formulations. Conclusion. Among the medications investigated, the injectables are the most significant source of aluminium for patients with renal insufficiency. This extra aluminium intake is reflected in higher aluminium levels in the patients’ blood.