The effect of an iron supplement on serum aluminum level and desferrioxamine mobilization test in hemodialysis patients

Background. The serum aluminum (Al) measurement with desferrioxamine (DFO) mobilization is a screening test for uremic patients with an Al overload. In these patients, body iron status is one of the factors affecting the serum Al level. This study is designed to elucidate the effects of iron supplements on the serum Al and the DFO mobilization test. Methods. Our study featured ten hemodialysis patients with iron deficiency anemia. The iron supplement was given intravenously with saccharated ferric oxide, 40 mg three times weekly, at the end of each hemodialysis. The total amount of iron supplement was 1,000 mg. All the patients underwent a DFO test at a dose of 5 mg/kg. The same test was repeated two weeks after completion of the iron supplement. Results. After the iron supplement, patients' iron deficiency anemia improved with a serum ferritin elevation from 312.4 ± 589.5 to 748.2 ± 566.2 μg/L (p < 0.01), and iron saturation from 21.6 ± 20.3 to 41.1 ± 21.7 % (p = 0.06). The basal serum Al level decreased from 34.3 ± 13.8 to 21.8 ± 8.5 μg/L (p = 0.01). In the DFO mobilization test, the peak serum Al level decreased from 63.4 ± 19.3 to 50.7 ± 20.5 μg/L (p < 0.01). The amount of Al increment (ΔAl) in DFO test was not changed (29.1 ± 12.0 vs. 28.9 ± 15.9 μg/L, p = 0.86). The change in basal Al level tended to negatively correlate with the percentage of increment in iron saturation (r = -0.628, p = 0.05). Conclusion. Results in this study suggest that iron supplements may significantly reduce the basal serum Al and peak Al in DFO mobilization test, without significant change of the mean ΔAl. The data presented indicate that in the interpretation of serum aluminum levels the iron status should be taken into account.