Reversal of Aluminum-Induced Hemodialysis Anemia by a Low-Aluminum Dialysate

ALUMINUM derived from tap water used to prepare dialysate is now thought to be the main cause of dialysis encephalopathy and vitamin D–resistant dialysis osteomalacia.1 2 3 4 Elliott and Macdougall5 were the first to observe a severe anemia preceding these problems; it has since been confirmed6 that the disorder is a microcytic anemia not due to iron deficiency. There was a high incidence of dialysis encephalopathy, osteomalacia, and an accompanying microcytic anemia in patients in our former chronic-hemodialysis unit. The dialysate used there was prepared from untreated tap water with high levels of aluminum. We carried out a prospective study of the . . .