Rapid removal of DFO-chelated aluminum during hemodialysis using polysulfone dialyzers

Abstract

Aluminum (Al) removal following deferoxamine (DFO) therapy in hemodialysis patients was evaluated in a paired-fashion comparing cuprophane (Travenol 12.11) and polysulfone (Fresenius F-80) dialyzers. Q(B) and Q(D) were held constant at 250 and 500 ml/min, respectively. The polysulfone dialyzer increased total plasma Al clearance from 20.0 ± 2.8 to 80.5 ± 7.6 ml/min (P < 0.01), and reduced the t 1/2 of plasma Al during hemodialysis from 538 ± 113 to 112 ± 12 min (P < 0.01). The polysulfone F-80 dialyzer increased Al removal during the first hour of hemodialysis from 518 ± 191 to 1812 ± 720 μg/hr (P < 0.01). During a four hour hemodialysis the F-80 dialyzer returned plasma Al levels to pre-DFO values (103 ± 36 vs. 93 ± 23, P < 0.05), suggesting complete removal of the DFO chelated Al complex. In one patient Al removal was evaluated using cuprophane, F-40, F-60 and F-80 dialyzers and the t 1/2 for Al removed decreased from 484.6 to 276.1 and 108 to 99 minutes, respectively. These data show the Fresenius F-80 polysulfone dialyzer effects the rapid removal of DFO-Al complexes. We propose use of the Fresenius F-80 dialyzer in conjunction with reduced DFO doses and i.m. administration of DFO the day prior to dialysis to limit DFO exposure as a method to decrease DFO-related side-effects in hemodialysis patients.