Aluminum Exposure in Chronic Renal Failure in Iberoamerica at the End of the 1990s: Overview and Perspectives

• Published in: The American journal of the medical sciences 2000-08, Vol.320 (2), p.96-99
• Main Authors: Fernández-Martín, José Luis, Canteros, Alejandra, Cannata-Andía, Jorge, Alles, Alberto, Massari, Pablo
• Format: Article
• Language: English
• Subjects: Aluminium exposure; Aluminum - analysis; Aluminum - poisoning; Biological and medical sciences; Dialysate; Dialysis Solutions - adverse effects; Dialysis Solutions - analysis; Dialysis Solutions - standards; Drug Contamination - prevention & control; Environmental Monitoring - standards; Humans; Investigative techniques, diagnostic techniques (general aspects); Kidney Failure, Chronic - blood; Kidney Failure, Chronic - therapy; Medical sciences; Osteomalacia - chemically induced; Osteomalacia - prevention & control; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Quality Assurance, Health Care; South America; Spain; Urinary system; Water Purification; Water Supply - analysis; Water treatment systems
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1097/00000441-200008000-00006

Epidemic aluminum neurotoxicity has virtually disappeared in the dialysis population; however, sporadic toxic effects caused by contamination of water with aluminum are still reported. In this review, the current situation in Iberoamerica is analyzed. Exposure to aluminum through dialysate shows considerable geographical differences even within the same country, including seasonal variability. Sometimes the tap water showed very high aluminum content that does not permit the water treatment system to efficiently remove all the aluminum, forcing the use of water treatment systems with a double reverse-osmosis filter on line. The use of adequate water treatment systems and a correct control policy has improved the quality of the dialysate, minimizing the aluminum exposure. However, an additional problem in Iberoamerica is the difficulty to obtain aluminum-free concentrates for the preparation of the final dialysis solution. Aluminum still seems to be implicated in a great percentage of symptomatic low-bone remodeling lesions in South America compared with Europe, demonstrating that exposure to aluminum through dialysate is still a cause of concern in some areas of the world.