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.