HDCN Article Review/Hyperlink

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)