Efficacy of low-dose desferrioxamine for the estimation of aluminium overload in naemodialysis patients
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In haemodialysis patients the desferrioxamine (DFO) test is an accepted method for estimating the body content of aluminium. However, toxic side effects have been frequently reported with the high-dose (30 or 40 mg/kg) DFO tests. To study if a low-dose (500 mg) DFO test was also useful and free of side effects, we compared it with a high-dose DFO test in 22 patients on regular haemodialysis.
During the first two hours of dialysis, 500 mg DFO in 100 ml 0.9% NaCl were administered intravenously. Before dialysis and after 48 hours aluminium concentration was determined in serum. In 14 patients the low-dose DFO test was considered positive. In 11 of those 14 patients the high-dose (30 mg/kg) DFO test was positive too. Analysis of the results showed a significant correlation (p < 0.05) between the outcome of the two DFO tests in the same patient. Compared to the high-dose DFO test, the low-dose test revealed a sensitivity of 79% and a specificity of 63%.
In contrast with the high-dose DFO test, the low-dose DFO test showed no toxic side effects.
We conclude that the low-dose DFO test might be a reliable and safe method for the estimation of the body content of aluminium in patients on regular haemodialysis.
KeywordsAluminium toxicity Desferrioxamine Haemodialysis
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- 1.Altmann P. Aluminium toxicity in dialysis patients: no evidence for a threshold serum aluminium concentration. Nephrol Dial Transplant 1993;Suppl.1:25–34.Google Scholar
- 2.CanaveseC, TheaA, PacittiA, SalomoneM, MangiarottiG, SegoloniG, et al. Prevention and treatment of aluminum overload in uremic patients: long-term results. Clin Nephrol 1989;31:169–74.Google Scholar
- 3.ChazanJA, LewNL, LowrieEG. Increased serum aluminum. an independent risk factor for mortality in patients undergoing long-term hemodialysis. Arch Intern Med 1991;151:319–22.Google Scholar
- 4.De Broe ME, D'Haese PC, Couttenye M-M, Van Landeghem GF, Lamberts LV. New insights and strategies in the diagnosis and treatment of aluminium overload in dialysis patients. Nephrol Dial Transplant 1993;Suppl.1:47–50.Google Scholar
- 5.MonteagudoFSE, CassidyMJD, FolbPl. Recent developments in aluminium toxicology. Med Toxicol Adverse Drug Exp 1989;4:1–16.Google Scholar
- 6.Hümpfner A, Hummel S, Schulz W. Diagnostic and therapeutic approaches to aluminium overload in dialysed patients-Representative study by questionnaire in West German dialysis units in 1989–1990. Nephrol Dial Transplant 1993;Suppl.1:51–4.Google Scholar
- 7.MallucheHH, FaugereM-C. Value of the®Desferal infusion test for diagnosis of aluminium bone disease in patients with end-stage renal failure. In DeBroeME, editor. Aluminium and iron overload in haemodialysis. Bern, Switzerland: Hogrefe & Huber, 1989:11–5.Google Scholar
- 8.DayJP, HewittCD, AckrillP. Chemistry and pharmacology of desterrioxamine as an aluminium chelator. In DeBroeME, editor. Aluminium and iron overload in haemodialysis. Bern, Switzerland: Hogrefe & Huber, 1989:42–8.Google Scholar
- 9.ReynoldsJEF, editor. Martindale, the extra pharmacopoeia, 30th edition. London, England: The Pharmaceutical Press, 1993:676–80.Google Scholar
- 10.Yawalkar SJ. Milestones in the research and development of desterrioxamine. Nephrol Dial Transplant 1993;Suppl.1:40–2.Google Scholar
- 11.VerpootenGA, D'HaesePC, BoelaertJR, BecausI, LambertsLV, DeBroeME. Pharmacokinetics of aluminoxamine and ferrioxamine and dose finding of desferrioxamine in haemodialysis patients. Nephrol Dial Transplant 1992;7:931–8.Google Scholar
- 12.McCarthyJT, MillinerDS, JohnsonWJ. Clinical experience with desferrioxamine in dialysis patients with aluminium toxicity. Q J Med 1990;275:257–76.Google Scholar
- 13.MillinerDS, NebekerHG, OttSM, AndressDL, SherrardDJ, AlfreyAC, et al.. Use of the deferoxamine infusion test in the diagnosis of aluminum-related osteodystrophy. Ann Intern Med 1984;101:775–80.Google Scholar
- 14.CoburnJW, NebekerHG, SegalR, MillinerD, OttSM, SlatopolskyEA, et al. Treatment of dialysed patients with desferrioxamine: successes and side-effects. In DeBroeME, editor. Aluminium and iron overload in haemodialysis. Bern, Switzerland: Hogrefe & Huber, 1989:49–55.Google Scholar
- 15.Boelaert JR, de Locht M. Side-effects of desferrioxamine in dialysis patients Nephrol Dial Transplant 1993;Suppl.1:43–6.Google Scholar
- 16.DeBroeME. Practical guidelines for the use of®Desferal. In DeBroeME, editor. Aluminium and iron overload in haemodialysis. Bern, Switzerland: Hogrefe & Huber, 1989:75–77.Google Scholar
- 17.YaqoobM, AhmadR, RobertsN, HelliwellT. Low-dose desferrioxamine test for the diagnosis of aluminium-related bone disease in patients on regular haemodialysis. Nephrol Dial Transplant 1991;6:484–6.Google Scholar
- 18.Consensus conference. Diagnosis and treatment of aluminium overload in end-stage renal failure patients. Nephrol Dial Transplant 1993;Suppl.1:1–4.Google Scholar
- 19.MallucheHH, SmithAJ, AbreoK, FaugereM-C. The use of deferoxamine in the management of aluminum accumulation in bone in patients with renal failure. New Engl J Med 1984;311:140–4.Google Scholar
- 20.D'HaesePC, CouttenyeMM, LambertsLV, GoodmanWG, NuytsGD, LemoniatouE, et al.. Value of the low-dose desferrioxamine test in the diagnosis of aluminium overload in dialysis patients. Nephrol Dial Transplant 1992;7:985.Google Scholar