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In the past, the major sources of aluminum exposure were dialysate water, aluminum-containing phosphate binders, and antacids. These sources have largely been eliminated, at least in the United States. The National Kidney Foundation’s KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines for the care of patients with end-stage renal disease include screening for aluminum toxicity with plasma aluminum concentrations at least yearly and quarterly in those receiving aluminum-containing medications (opinion). KDIGO (Kidney Disease: Improving Global Outcomes) recommends avoiding long-term use of aluminum-containing phosphate binders and, in patients with chronic kidney disease stage 5, dialysate aluminum decontamination to prevent aluminum intoxication. Because the acceptable dose and duration of a “short course” of an aluminum-containing phosphate binder is not well defined and exposure to aluminum is cumulative, we have not prescribed medications known to contain aluminum at our center for the past 10 years. However, we continued to monitor aluminum concentrations in all hemodialysis patients quarterly because of concerns that exposure might continue from medications used without our knowledge, such as over-the-counter antacids and sucralfate (21% aluminum by weight), and from smaller amounts of aluminum found in other medications not typically considered dangerous to hemodialysis patients (). Recently, the incidence of abnormal aluminum concentrations in dialysis patients has been reported to be as low as 2.1%. This calls into question the value of screening aluminum measurements in a population no longer being treated with aluminum-containing medications.

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