Aluminum Toxicity: Evaluation of 16-Year Trend Among 14 919 Patients and 45 480 Results

Abstract

Context.— Annual monitoring with serum aluminum measurements is recommended for dialysis patients who are susceptible to toxic accumulation from contaminated dialysis fluid or from ingestion of aluminum-containing medications. Objective.— To evaluate long-term trends in serum aluminum concentrations and frequency of chronic toxicity. Design.— A retrospective observational study was conducted by analyzing serum aluminum results obtained from the Veterans Affairs corporate data warehouse. Serum aluminum concentrations of 60 μg/L or greater were considered false positives and not indicative of chronic toxicity if another specimen retested within 45 days had a concentration below 20 μg/L. Results.— A total of 45 480 serum aluminum results involving 14 919 patients and 119 Veteran Affairs facilities during a 16-year period ending in October 2016 were evaluated. The percentage of elevated (≥20 μg/L) serum aluminum results declined from 31.5% in 2000 to 2.0% in 2015. Average testing intervals changed from every 159 days in 2000 to every 238 days in 2015. Of 529 patients with serum aluminum concentrations of 60 μg/L or greater, 216 (40.8%) were retested within 45 days (average = 21 days); of these, 83 (38.4%) had concentrations below 20 μg/L after repeated measurements. Retesting rates increased with higher initial serum aluminum concentrations. Conclusions.— Aluminum toxicity, as assessed by serum levels, has substantially declined over time and is now rare. Many serum aluminum concentrations in the toxic range were not confirmed after retesting. Patients with toxic serum aluminum concentrations should be retested with another specimen before undergoing treatment or investigating sources of exposure to verify abnormal results.