Aluminum-induced anemia.

Although many questions still remain unanswered, it is clear that aluminum causes a microcytic hypoproliferative anemia and is one factor responsible for worsening anemia in patients with end-stage renal disease. Time course studies in a rat model have shown that the anemia is preceded by microcytosis; this has not yet been examined in man. The exact mechanism of aluminum-induced anemia is unknown, however it appears to involve inhibition of heme synthesis, either by inhibition of enzyme activity or interference with iron incorporation or utilization. The interrelationship between aluminum and iron, zinc, lead, or other metals in this anemia is also unknown, as are the effects of aluminum on erythroid colony forming units. The role of parathyroid hormone on aluminum-induced anemia has not been examined. Presently treatment of aluminum-induced anemia involves removal of the source of the aluminum, although recent studies with desferrioxamine show promise. It is unclear, however, exactly how desferrioxamine improves this anemia. It is clear, however, that aluminum in the dialysate can cause clinical problems including anemia, and that these problems can be substantially reduced if not eliminated by water treatment.