Patients in renal failure not receiving dialysis therapy invariably have serum aluminum levels above the 60 ng/mL range.
McCarthy(1) and Hernandez(2) describe a biochemical profile that is characteristic of aluminum overload disease in dialysis patients:
-Patients in renal failure with no signs or symptoms of osteomalacia or encephalopathy usually had serum aluminum <20 ng/mL and parathyroid hormone (PTH) concentrations >150 pg/mL, which is typical of secondary hyperparathyroidism.
-Patients with signs and symptoms of osteomalacia or encephalopathy had serum aluminum >60 ng/mL and PTH concentrations <50 pg/mL (PTH above the reference range, but low for secondary hyperparathyroidism).
-Patients who had serum aluminum >60 ng/mL and <100 ng/mL were identified as candidates for later onset of aluminum overload disease that required aggressive efforts to reduce their daily aluminum exposure. This was done by switching them from aluminum-containing phosphate binders to calcium-containing phosphate binders, by ensuring that their dialysis water had <10 ng/mL of aluminum and ensuring the albumin used during postdialysis therapy was aluminum-free.
Prosthesis wear is known to result in increased circulating concentration of metal ions.(3) Modest increase (6-10 ng/mL) in serum aluminum concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations >10 ng/mL in a patient with an aluminum-based implant not undergoing dialysis suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.