177
Letters 2. Koyama H, Tabata T, Nishizawa Y, Inoue T, Morii H, Yamaji T. Plasma endothelin levels in patients with uraemia. Lancet 1989; 1: 991-992 3. Warrens AN. Cassidy JD, Takahashi K, Ghatei MA, Bloom SR. Esdcthclin in renal failure. Sephrol Dial Tran\plant 1989; 5: 418^422 4. Yanagisawa M, Kurihara H, Kimura S et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Samre 1988:332:411-415
p=0.03 O) 3.
20
- p= 0.0004
-N.S.
I 10 Higher serum aluminium concentrations in irondepleted dialysis patients Sir, In a recent cross-sectional study [1] we noted that of 133 dialysis patients no single patient was found showing the combination of increased serum ferritin (> 1000 ug/ml) and an elevated serum aluminium (> 100 ug/1). To further investigate this aspect a multicentre (n = 17) study including 522 dialysis patients was performed in Belgium. Serum aluminium and serum ferritin were determined in each subject. Patients had not received desferrioxamine during the last 2 years preceding the study. Out of the total population 198 patients showed a serum ferritin concentration < 100 ug/1 and were considered to be iron depleted (group 1). The latter threshold value was derived from a previous study correlating serum ferritin with the total body iron [2]. Two hundred and eighty-eight patients presented with a serum ferritin ranging between 100 and 800 ug/1 (group 2), while 43 patients were found to be iron overloaded (group 3) as indicated by a serum ferritin > 800 ug/1. In the latter group, six patients with a history of hepatitis B infections and one subject presenting with cholestasis and metastasis of the liver were excluded. Chisquare analysis was used for statistical analysis and a P value < 0.05 was considered significant. Results shown in Figure 1 reveal a significantly greater prevalence (17.2%) of patients with serum aluminium > 50 ug/1 in the iron-depleted group compared to those with normal iron status (6.9%; P=0.0004) and to those with iron overload (2.8%) (P = 0.0259). The prevalence of serum aluminium concentrations > 50 ug/1 did not significantly differ between groups 2 and 3.
o 8 5 20288 100
100-800 Serum Ferritin (ng'ml)
800
Fig. 1. Prevalence of serum aluminium concentrations in excess of 50 ug 1 in haemodialysis patients with serum ferritin below 100 ug,l (n= 198), 100-800 ug/1 (n = 288), and in excess of 800 ug/1 (n = 36).
These data are in agreement with recent observations of Cannata et al. [3] in the rat, suggesting an increased aluminium absorption in iron deficiency. These observations gain in interest in view of the increased prevalence of iron depletion that has been observed in dialysis patients treated with recombinant erythropoietin. Department of Nephrology-Hypertension J. L. Vanuytsel University of Antwerp P. C. D'Haese Belgium M. M. Couttenye M. E. De Broe 1. D'Haese PC, Clement JP, Elseviers MM, Lamberts LV, Van de Vyver FL, De Broe ME. Value of serum aluminium monitoring in dialysis patients: a multicentre study. Nephrol Dial Transplant 1990; 5: 45-53 2. Van de Vyver FL, Vanheule AO, Majelyne WM et al. Serum ferritin as a guide for iron stores in chronic hemodialysis patients. Kidney Int 1984; 26: 451-458 3. Cannata JB, Fernandez-Soto I, Fernandez-Menendez MJ el al. Role of iron metabolism in absorption and cellular uptake of aluminium. Kidney Int 1991; 39: 799-803
Letters 2. Koyama H, Tabata T, Nishizawa Y, Inoue T, Morii H, Yamaji T. Plasma endothelin levels in patients with uraemia. Lancet 1989; 1: 991-992 3. Warrens AN. Cassidy JD, Takahashi K, Ghatei MA, Bloom SR. Esdcthclin in renal failure. Sephrol Dial Tran\plant 1989; 5: 418^422 4. Yanagisawa M, Kurihara H, Kimura S et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Samre 1988:332:411-415
p=0.03 O) 3.
20
- p= 0.0004
-N.S.
I 10 Higher serum aluminium concentrations in irondepleted dialysis patients Sir, In a recent cross-sectional study [1] we noted that of 133 dialysis patients no single patient was found showing the combination of increased serum ferritin (> 1000 ug/ml) and an elevated serum aluminium (> 100 ug/1). To further investigate this aspect a multicentre (n = 17) study including 522 dialysis patients was performed in Belgium. Serum aluminium and serum ferritin were determined in each subject. Patients had not received desferrioxamine during the last 2 years preceding the study. Out of the total population 198 patients showed a serum ferritin concentration < 100 ug/1 and were considered to be iron depleted (group 1). The latter threshold value was derived from a previous study correlating serum ferritin with the total body iron [2]. Two hundred and eighty-eight patients presented with a serum ferritin ranging between 100 and 800 ug/1 (group 2), while 43 patients were found to be iron overloaded (group 3) as indicated by a serum ferritin > 800 ug/1. In the latter group, six patients with a history of hepatitis B infections and one subject presenting with cholestasis and metastasis of the liver were excluded. Chisquare analysis was used for statistical analysis and a P value < 0.05 was considered significant. Results shown in Figure 1 reveal a significantly greater prevalence (17.2%) of patients with serum aluminium > 50 ug/1 in the iron-depleted group compared to those with normal iron status (6.9%; P=0.0004) and to those with iron overload (2.8%) (P = 0.0259). The prevalence of serum aluminium concentrations > 50 ug/1 did not significantly differ between groups 2 and 3.
o 8 5 20288 100
100-800 Serum Ferritin (ng'ml)
800
Fig. 1. Prevalence of serum aluminium concentrations in excess of 50 ug 1 in haemodialysis patients with serum ferritin below 100 ug,l (n= 198), 100-800 ug/1 (n = 288), and in excess of 800 ug/1 (n = 36).
These data are in agreement with recent observations of Cannata et al. [3] in the rat, suggesting an increased aluminium absorption in iron deficiency. These observations gain in interest in view of the increased prevalence of iron depletion that has been observed in dialysis patients treated with recombinant erythropoietin. Department of Nephrology-Hypertension J. L. Vanuytsel University of Antwerp P. C. D'Haese Belgium M. M. Couttenye M. E. De Broe 1. D'Haese PC, Clement JP, Elseviers MM, Lamberts LV, Van de Vyver FL, De Broe ME. Value of serum aluminium monitoring in dialysis patients: a multicentre study. Nephrol Dial Transplant 1990; 5: 45-53 2. Van de Vyver FL, Vanheule AO, Majelyne WM et al. Serum ferritin as a guide for iron stores in chronic hemodialysis patients. Kidney Int 1984; 26: 451-458 3. Cannata JB, Fernandez-Soto I, Fernandez-Menendez MJ el al. Role of iron metabolism in absorption and cellular uptake of aluminium. Kidney Int 1991; 39: 799-803
