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A Report From the End-Stage Renal Disease Network 28

Andrew S. Brem, MD; Cindy DiMario, RN; David L. Levy, MD

Arch Intern Med. 1989;149(11):2541-2544.

Abstract
• A survey to assess the perceived prevalence of aluminumrelated disease was conducted by the Medical Review Board of the End-Stage Renal Disease Network 28 from 1986 to 1987. Responses were obtained for 855 of 3000 patients on dialysis representing 17 of 39 participating dialysis units within the network. Almost 40% of the patients surveyed had been receiving dialysis therapy for over 3 years. Patients on hemodialysis (83% of the study group) had the water used to prepare the dialysate pretreated. Serum aluminum determinations were obtained in 240 (28%) of the 855 patients; other methods of assessing body aluminum burden were performed in less than 10% of the survey population. When obtained, elevated serum aluminum measurements were more likely to be found with each year patients were given dialysis and with each year patients were treated with oral aluminum gels. With the exception of patients with bone pain, clinical signs and symptoms did not correlate with elevated serum aluminum. However, the prevalence of muscle weakness, bone pain, fractures, and dementia in the survey group did correlate with years on dialysis and/or years receiving oral aluminum gels. Data gathered from this survey are consistent with the view that signs and symptoms suggestive of an increased body aluminum burden occur in the minority of patients on dialysis. Nevertheless, patients at risk for aluminum intoxication (years on dialysis, years receiving gels, patients with clinical signs) may not be adequately identified.

(Arch Intern Med. 1989;149:2541-2544)

Author Affiliations
From the End-Stage Renal Disease Network 28, Medical Review Board, Boston, Mass (restructured as End-Stage Renal Disease Network 1 of New England, Inc, New Haven, Conn).

Footnotes
Accepted for publication July 31, 1989.

Reprint requests to Division of Pediatric Nephrology, Rhode Island Hospital SWP 4, 593 Eddy St, Providence, RI 02902 (Dr Brem).

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