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Article Review/Hyperlink
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Barata JD, D'Haese PC, Pires C, Lamberts LV, Simoes J, DeBroe
ME
Low dose (5 mg/kg) desferrioxamine treatment in acutely
aluminium-intoxicated haemodialysis patients using two drug
administration schedules
Nephrol Dial Transplant
(Jan) 11:125-132 1996

A local municipal authority added large amounts of aluminium sulfate
to the water supply of a small (but quaint) town in Portugal causing
failure of RO membranes in a hemodialysis unit and an epidemic of
acute aluminum intoxication. By replacing the RO system, changing the
water supply, stopping Al containing phosphorus binders, and
increasing the frequency of dailysis along with hemoperfusion, the
basal Al levels decreased without the use of DFO from 506+/-255 ug/L
to 121+/-46 ug/L after six weeks. The authors then divided the 41
patients into those who developed symptoms after a 5 mg/kg dose of DFO
and/or Al level greater than 300 ug/L 44 hours after an infusion
(group 1) and those who did not (group 2). Those in group 1 received
5 mg/kg DFO 5 hours prior to a hemodialysis/hemoperfusion session done
weekly and those in group 2 received the same amount of DFO during the
last hour of conventional dialysis followed by
hemodialysis/hemoperfusion 44 hours later. Aluminum levels decreased
in both groups over the 9 months of follow-up. There were no
side-effects related to DFO in either groups. The authors update a
strategy for the treatment of Al overload in this circumstance (see
figure 7).
Comment: This should never have happened with state of the art
water treatment technology. Nonetheless, the study confirms that the
current strategies to treat acute aluminum intoxication seem to work
pretty well. High flux dialyzers should be used in this situation if
available. (James A. Delmez, M.D., Washington University at St.
Louis, Missouri)
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