Aluminum-citrate interaction in end-stage renal disease

D. Rudy; D. A. Sica; T. Comstock; J. Davis; J. Savory; A. C. Schoolwerth

doi:10.1177/039139889101401004

Aluminum-citrate interaction in end-stage renal disease

D. Rudy, D. A. Sica, T. Comstock, J. Davis, J. Savory, A. C. Schoolwerth

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Abstract

The influence of a sodium citrate/citric acid mixture on the gastrointestinal (GI) absorption of aluminum (Al) from an Al(OH)₃ preparation was evaluated in six stable maintenance hemodialysis patients. Plasma Al concentrations were determined serially after each of the following treatment sequences (I) Al(OH)₃; (II) Al(OH)₃ + sodium citrate/citric acid; (III) sodium citrate/citric acid; (IV) Al(OH)₃ + NaHCO₃. AUC_0-8 for plasma Al from 0 to 8 hours was significantly greater (p < 0.05) for Al(OH)₃ + sodium citrate/citric acid (73 ± 23 μg · hr/l; mean ± SEM) than Al(OH)₃ (16 ± 30 μg · hr/l); sodium citrate/citric acid (-27 ± 14 μg · hr/l); or Al(OH)₃ + NaHCO₃ (6 ± 22 μg · hr/l). The 24 hour Al level remained above baseline (p < 0.03) following Al(OH)₃ + sodium citrate/citric acid (31 ± 12 (pre) vs 54 ± 14 μg/l (post), in contradistinction to study limb: I (34 ± 14 vs 30 ± 12 μg/l); III (79 ± 40 vs 65 ±35 μg/l); and IV (71 ± 37 vs 66 ± 42 μg/l). We conclude that the GI absorption of Al from Al(OH)₃ is enhanced by citrate in patients undergoing hemodialysis and that elevations of plasma Al persist longer. The concomitant administration of citrate and Al-containing phosphate (PO₄) binders should be avoided in patients with end-stage renal disease (ESRD). NaHCO₃ may serve as an alternative therapy for metabolic acidosis with less risk of enhancing Al absorption.

Original language	English
Pages (from-to)	625-629
Number of pages	5
Journal	International Journal of Artificial Organs
Volume	14
Issue number	10
DOIs	https://doi.org/10.1177/039139889101401004
State	Published - 1991

ASJC Scopus subject areas

Bioengineering
Medicine (miscellaneous)
Biomaterials
Biomedical Engineering

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@article{8745082a4db249a4953855d31d1a6299,

title = "Aluminum-citrate interaction in end-stage renal disease",

abstract = "The influence of a sodium citrate/citric acid mixture on the gastrointestinal (GI) absorption of aluminum (Al) from an Al(OH)3 preparation was evaluated in six stable maintenance hemodialysis patients. Plasma Al concentrations were determined serially after each of the following treatment sequences (I) Al(OH)3; (II) Al(OH)3 + sodium citrate/citric acid; (III) sodium citrate/citric acid; (IV) Al(OH)3 + NaHCO3. AUC0-8 for plasma Al from 0 to 8 hours was significantly greater (p < 0.05) for Al(OH)3 + sodium citrate/citric acid (73 ± 23 μg · hr/l; mean ± SEM) than Al(OH)3 (16 ± 30 μg · hr/l); sodium citrate/citric acid (-27 ± 14 μg · hr/l); or Al(OH)3 + NaHCO3 (6 ± 22 μg · hr/l). The 24 hour Al level remained above baseline (p < 0.03) following Al(OH)3 + sodium citrate/citric acid (31 ± 12 (pre) vs 54 ± 14 μg/l (post), in contradistinction to study limb: I (34 ± 14 vs 30 ± 12 μg/l); III (79 ± 40 vs 65 ±35 μg/l); and IV (71 ± 37 vs 66 ± 42 μg/l). We conclude that the GI absorption of Al from Al(OH)3 is enhanced by citrate in patients undergoing hemodialysis and that elevations of plasma Al persist longer. The concomitant administration of citrate and Al-containing phosphate (PO4) binders should be avoided in patients with end-stage renal disease (ESRD). NaHCO3 may serve as an alternative therapy for metabolic acidosis with less risk of enhancing Al absorption.",

author = "D. Rudy and Sica, {D. A.} and T. Comstock and J. Davis and J. Savory and Schoolwerth, {A. C.}",

year = "1991",

doi = "10.1177/039139889101401004",

language = "English",

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T1 - Aluminum-citrate interaction in end-stage renal disease

AU - Rudy, D.

AU - Sica, D. A.

AU - Comstock, T.

AU - Davis, J.

AU - Savory, J.

AU - Schoolwerth, A. C.

PY - 1991

Y1 - 1991

N2 - The influence of a sodium citrate/citric acid mixture on the gastrointestinal (GI) absorption of aluminum (Al) from an Al(OH)3 preparation was evaluated in six stable maintenance hemodialysis patients. Plasma Al concentrations were determined serially after each of the following treatment sequences (I) Al(OH)3; (II) Al(OH)3 + sodium citrate/citric acid; (III) sodium citrate/citric acid; (IV) Al(OH)3 + NaHCO3. AUC0-8 for plasma Al from 0 to 8 hours was significantly greater (p < 0.05) for Al(OH)3 + sodium citrate/citric acid (73 ± 23 μg · hr/l; mean ± SEM) than Al(OH)3 (16 ± 30 μg · hr/l); sodium citrate/citric acid (-27 ± 14 μg · hr/l); or Al(OH)3 + NaHCO3 (6 ± 22 μg · hr/l). The 24 hour Al level remained above baseline (p < 0.03) following Al(OH)3 + sodium citrate/citric acid (31 ± 12 (pre) vs 54 ± 14 μg/l (post), in contradistinction to study limb: I (34 ± 14 vs 30 ± 12 μg/l); III (79 ± 40 vs 65 ±35 μg/l); and IV (71 ± 37 vs 66 ± 42 μg/l). We conclude that the GI absorption of Al from Al(OH)3 is enhanced by citrate in patients undergoing hemodialysis and that elevations of plasma Al persist longer. The concomitant administration of citrate and Al-containing phosphate (PO4) binders should be avoided in patients with end-stage renal disease (ESRD). NaHCO3 may serve as an alternative therapy for metabolic acidosis with less risk of enhancing Al absorption.

AB - The influence of a sodium citrate/citric acid mixture on the gastrointestinal (GI) absorption of aluminum (Al) from an Al(OH)3 preparation was evaluated in six stable maintenance hemodialysis patients. Plasma Al concentrations were determined serially after each of the following treatment sequences (I) Al(OH)3; (II) Al(OH)3 + sodium citrate/citric acid; (III) sodium citrate/citric acid; (IV) Al(OH)3 + NaHCO3. AUC0-8 for plasma Al from 0 to 8 hours was significantly greater (p < 0.05) for Al(OH)3 + sodium citrate/citric acid (73 ± 23 μg · hr/l; mean ± SEM) than Al(OH)3 (16 ± 30 μg · hr/l); sodium citrate/citric acid (-27 ± 14 μg · hr/l); or Al(OH)3 + NaHCO3 (6 ± 22 μg · hr/l). The 24 hour Al level remained above baseline (p < 0.03) following Al(OH)3 + sodium citrate/citric acid (31 ± 12 (pre) vs 54 ± 14 μg/l (post), in contradistinction to study limb: I (34 ± 14 vs 30 ± 12 μg/l); III (79 ± 40 vs 65 ±35 μg/l); and IV (71 ± 37 vs 66 ± 42 μg/l). We conclude that the GI absorption of Al from Al(OH)3 is enhanced by citrate in patients undergoing hemodialysis and that elevations of plasma Al persist longer. The concomitant administration of citrate and Al-containing phosphate (PO4) binders should be avoided in patients with end-stage renal disease (ESRD). NaHCO3 may serve as an alternative therapy for metabolic acidosis with less risk of enhancing Al absorption.

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Aluminum-citrate interaction in end-stage renal disease

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