Burwen DR, Olsen St, Bland LA, Arduino MJ, Reid MH, Jarvis WR
Epidemic aluminum intoxication in hemodialysis patients traced to use of an aluminum pump

Kidney Int (Aug) 48:469-474 1995

This is a CDC case control study of elevated serum aluminum levels (>100 ug/liter, often 300-500, sometimes > 500 ug/liter) which occurred in 1991 in patients treated at a dialysis unit in Pennsylvania. Many of the patients had mental status changes and other neurologic symptoms. The problem was traced to an aluminum pump used to pump concentrate from a storage tank. As long as acetate concentrate was used, the problem appeared to be minimal. However, after switching to bicarbonate dialysate, when the pump was used to move acid concentrate, high patient aluminum levels and symptoms of aluminum intoxication increased dramatically in frequency. In vitro testing of the pump confirmed leaching of large amounts of aluminum from the pump into acid concentrate. Replacing the aluminum pump with one made of plastic solved the problem. Continued vigilance about occult sources of aluminum exposure in dialysis patients is warranted. (Daugirdas)

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