A survey to assess the perceived prevalence of
aluminum-related disease was conducted by the Medical Review Board of the
End-Stage Renal Disease Network 28 from 1986 to 1987. Responses were obtained for 855 of 3000 patients on dialysis representing 17 of 39 participating dialysis units within the network. Almost 40% of the patients surveyed had been receiving dialysis
therapy for over 3 years. Patients on
hemodialysis (83% of the study group) had the water used to prepare the
dialysate pretreated. Serum
aluminum determinations were obtained in 240 (28%) of the 855 patients; other methods of assessing body
aluminum burden were performed in less than 10% of the survey population. When obtained, elevated serum
aluminum measurements were more likely to be found with each year patients were given dialysis and with each year patients were treated with oral
aluminum gels. With the exception of patients with bone
pain, clinical signs and symptoms did not correlate with elevated serum
aluminum. However, the prevalence of
muscle weakness, bone
pain, fractures, and
dementia in the survey group did correlate with years on dialysis and/or years receiving oral
aluminum gels. Data gathered from this survey are consistent with the view that signs and symptoms suggestive of an increased body
aluminum burden occur in the minority of patients on dialysis. Nevertheless, patients at risk for
aluminum intoxication (years on dialysis, years receiving
gels, patients with clinical signs) may not be adequately identified.