Deferoxamine and coated charcoal hemoperfusion to remove aluminum in dialysis patients

• Published in: Kidney international Vol. 34; no. 6; pp. 804 - 808
• Main Authors: McCarthy, James T., Milliner, Dawn S., Schmidt, David F., Schniepp, Brian J., Kurtz, Stephen B., Johnson, William J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-1988; Nature Publishing
• Subjects: Aluminum - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Charcoal; Deferoxamine - therapeutic use; Emergency and intensive care: renal failure. Dialysis management; Hemoperfusion; Humans; In Vitro Techniques; Intensive care medicine; Medical sciences; Renal Dialysis; Human; Extrarenal dialysis; Hemodialysis; Toxicity; Activated carbon; Hemoperfusion; Aluminium; Resuscitation
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.1988.253

Deferoxamine and coated charcoal hemoperfusion to remove aluminum in dialysis patients. We studied the in vitro and in vivo characteristics of aluminum (Al) removal by coated charcoal hemoperfusion (HP) in combination with intravenous deferoxamine (DFO). DFO enhanced the clearance of Al by HP in vitro after 180 minutes of perfusion with a solution containing 403.3 ± 14.0 ng/ml of Al at 150ml/min. The Al clearance was 139 ± 1.0ml/min with DFO and 49 ± 10.0ml/min (P < 0.001) without DFO. Addition of DFO enhanced in vitro Al removal from 5.5 ± 0.9mg to 10.0 ± 1.2mg (P < 0.05). During our in vivo studies, an HP device was in series in thé dialysis circuit after a Cuprophan hemodialyzer. Eight patients with Al toxicity were studied on twelve occasions. Patients received DFO (40mg/kg) 40 hours before the study. The total Al clearance with the combined hemodialysis (HD) and HP devices was higher than that obtained by the dialyzer alone at 30 minutes (62 ± 4.9ml/min vs. 25 ± 2.5ml/min, P < 0.02) and after 180 to 210 minutes (32 ± 3.0ml/min vs. 19 ± 2.9ml/min P < 0.02). After 120 minutes the Al clearance by the HP device alone was significantly lower than the initial Al clearance by HP. Combined HD plus HP removed 2.9 ± 0.4mg of Al, whereas the total removal of Al by HD alone was 1.5 ± 0.3mg (P < 0.01).