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Increased Serum Al Levels in Hemodialysis Patients Kept Enhanced during a 2-Year Prospective Study

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Abstract

The regulation of mineral homeostasis is altered in hemodialysis patients with renal insufficiency, producing increased risk for secondary diseases like cardiovascular ones. We hypothesized that risen serum aluminum (Al) concentration in hemodialysis patients kept enhanced during a 2-year longitudinal study is associated with enhanced cardiovascular risk and influenced by medical treatments. This study reports the prospective monitoring of serum Al levels in six-monthly samplings over 2 years in 116 hemodialysis patients and a control group of 50 healthy adults. The influence of other factors like sex, age, kidney transplant, disease etiology, and drug consumption was also considered. At each sampling, serum Al levels were significantly higher in the patients than in the healthy controls (P < 0.05). Levels in the patient group were statistically significantly lower at the third and fourth versus first and second samplings, which may be related to Al accumulation in tissues. Increased Al levels in patients were positively and significantly related to serum calcium (Ca) and uric acid levels. Serum Al concentrations were significantly lower in patients receiving vasodilators and diuretics. Higher serum Al levels in hemodialyzed patients administered with phosphate binders or anti-hyperkalemics are attributable to their usual Al salt content. The consumption of antianemic drugs increases Al absorption by forming more bioavailable complexes with the compounds in these drugs. In conclusion, this is the first study to indicate that cardiovascular problems associated with elevated serum Al levels in hemodialysis patients may be in part mitigated by administrating vasodilators and diuretics, which reduce these levels.

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Acknowledgement

This study was financially supported by research funds from project AGR-141 from the Consejería, Ciencia y Empresa (Junta de Andalucía) and developed into the Doctorate Program of Nutrition and Food Science (University of Granada). The authors thank Richard Davies for the assistance with the English version.

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Authors and Affiliations

  1. Department of Nutrition and Food Science, School of Pharmacy, University of Granada, 18071, Granada, Spain

    Maria L. Reina de la Torre, Herminia Lopez García de la Serrana, Loreto Martí del Moral & Miguel Navarro-Alarcón

  2. Department of Hemodialysis, Guadix Hospital, Granada, Spain

    Magdalena Palomares Bayo

Authors
  1. Maria L. Reina de la Torre
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  2. Herminia Lopez García de la Serrana
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  3. Loreto Martí del Moral
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  4. Magdalena Palomares Bayo
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  5. Miguel Navarro-Alarcón
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Correspondence to Miguel Navarro-Alarcón.

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Reina de la Torre, M.L., Lopez García de la Serrana, H., Martí del Moral, L. et al. Increased Serum Al Levels in Hemodialysis Patients Kept Enhanced during a 2-Year Prospective Study. Biol Trace Elem Res 178, 7–13 (2017). https://doi.org/10.1007/s12011-016-0902-1

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  • DOI: https://doi.org/10.1007/s12011-016-0902-1

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