Serum Aluminum Level and Its Relation with Parathyroid Hormone and Anemia in Children on Maintenance Hemodialysis

Aim: Renal excretion of aluminum is impaired in patients with chronic kidney disease, thereby increasing the risk of toxicity. Our aims were to determine the serum aluminum level in children on regular haemodialysis and to assess the effect of aluminum on PTH and blood parameters.
Methodology: This is a case control study was done on 120 children, a group of 60 cases on regular hemodialysis, their ages ranged from 3 to 16 year. They were 27 males (45%) and 33 females (55%) they were selected from the hemodialysis unit and outpatient clinic of Al-Zahraa hospital, AL-Azhar University during the period from January 2014 to September 2014. The studied cases were divided into two groups according to the serum aluminum level; group A< 50 µg/L, and group B > 50 µg/L. Another group of 60 apparently healthy children with matched age and sex with the patient group served as a control. All subjects underwent thorough history taking, clinical examination and the following investigations: complete blood count, blood urea, serum creatinine, total serum calcium, serum phosphorus, serum aluminum, ferritin, PTH and aluminum level of drinking water and water for dialysis.
Results: In this study serum aluminum level was significantly higher in cases compared with controls, it was (60±20 µg/L) and (20±10 µg/L) respectively (P=.000). Also we found serum PTH was significantly higher while serum calcium was significantly lower in cases compared to controls particularly in children whose aluminum >50 µg/L. We found a significant positive correlation between serum aluminum levels with PTH (r=.50, P=.001). Also our study reported that the aluminum level in both tap water (for drinking) and water from the dialysis unit their levels were 300 µg/L and 1 µg/L respectively.
Conclusion: Drinking water is the main source of high aluminum level in our study and its overload is still a serious health problem in hemodialysis children. So aluminum should be diminished from drinking water to reach the permissible limit; routine monitoring of aluminum level and new modalities of hemodialysis is recommended.