The following is the summary of “Aluminum overload in the reverse osmosis dialysis era: does it exist?” published in the December 2022 issue of Renal failure by Chen, et al.

One of the known risks of dialysis is aluminum buildup. There may no longer be a need to worry about aluminum overload because of advancements in hemodialysis technology. Although aluminum binders are still used, there is some evidence to show that metal overload is decreasing as a result of the era of aluminum removal from dialysis fluids. Desferrioxamine (DFO) test results for aluminum overload were analyzed by looking at data from January 2014 through June 1, 2020 that was located in their  electronic records. Aluminum overload was documented in terms of symptoms, diagnostic workup, and therapy.

A total of 99 dialysis patients signed up for the DFO study. One patient with an unexplained fracture, eight patients with anemia despite high-dose erythropoiesis-stimulating medications, and 5 patients with hypercalcemia (serum calcium >11 mg dL-1) were among the 47 patients who tested positive for aluminum overload using DFO. Patients with aluminum excess did not have any encephalopathy. Microcytic anemia affected just 4% of the 47 cases. Long-term therapy patients (>10 months) had a higher serum aluminum level following DFO (P=0.041), but had a similar basal serum aluminum level as short-term patients (P=0.219). 

Treatments in the aluminum overload group lowered erythropoietin dosages, as measured by blood total alkaline phosphatase levels 60 U L-1 (P=0.028). Researchers concluded that there was aluminum excess throughout the time of hemodialysis. Reverse osmosis dialysis patients in countries where aluminum-based phosphate binders are used should have their serum aluminum levels monitored due to the presence of less visible signs such as anemia and changes in bone turnover.