Aluminum-Containing Phosphate Binding Agents and Plasma Aluminum Levels in Children Undergoing CAPD: Preliminary Results with the Use of Calcium Carbonate

Abstract

Aluminum-containing phosphate binders are the principal therapy utilized to prevent the development of hyperphosphatemia and secondary hyperparathyroidism in patients with chronic renal failure [1]. Furthermore, the use of vitamin D sterols, which can aid in suppressing hyperparathyroidism, may increase intestinal phosphate absorption, thereby increasing the required dosage of phosphate binders [2–3]. Berlyne et al. [4] first reported that hyperaluminemia can occur after the ingestion of aluminum (Al)-containing anti-acids. Kaehny et al. [5] have confirmed that small amounts of Al can be absorbed after the ingestion of Al hydroxide gels. Initial reports from Europe demonstrated a strong association between the use of Al-contaminated water for preparing dialysate and the prevalence of osteomalacia and encephalopathy in adult dialysis patients [6]. Furthermore, the incidence of osteomalacic bone disease was reduced following the initiation of appropriate water purification [7]. Recently, both encephalopathy and Al-related osteomalacia have been described in infants and adults with advanced chronic renal failure prior to the initiation of dialysis [8–14]. The development of these abnormalities was associated with the ingestion of large quantities of Al-containing phosphate binding agents. Such observations implicate Al absorption from the gastrointestinal tract as the major source of Al accumulation in these patients.

Supported in part by grants AM 28368 and AM 29926 from the National Institute of Health, by the Peter Boxenbaum Fund, and by the Research Fund of the Veterans’ Administration.