Role of aluminum hydroxide in raising serum aluminum levels in children undergoing continuous ambulatory peritoneal dialysis.

Serum aluminum concentrations were measured in 16 children undergoing continuous ambulatory peritoneal dialysis after 7.9 +/- 2.1 (mean +/- SE) and 16.6 +/- 2.3 months of therapy, when the estimated simultaneous oral Al intake from Al hydroxide gels was 98 +/- 20 and 104 +/- 32 mg/kg/day, respectively. Serum Al concentrations were 55.2 +/- 11.4 and 59.8 +/- 10.4 micrograms/L, respectively, compared to 8.2 +/- 1.1 micrograms/L in normal children (P less than 0.001). Serum Al levels correlated with oral Al intake (r = 0.86, P less than 0.001) and inversely with body weight (r = -0.68, P less than 0.01) and age (r = -0.67, P less than 0.01). The youngest patient with the highest serum Al concentrations (208 and 174 micrograms/L) and greatest Al intake (310 and 192 mg/kg/day) had bone biopsy features characteristic of aluminum-related bone disease. Thus, higher aluminum intake per kilogram body weight given to young children is likely to raise the serum Al levels and increase the risk of osteomalacia. Aluminum-containing antacids should be used with caution in infants and young children with renal failure.