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In patients with chronic renal failure undergoing haemodialysis, aluminium toxicity may contribute to the observed skeletal changes. Aluminium accumulates in bone at the interface between mineralised bone and osteoid - the mineralisation front. It may suppress osteoblast activity and may accumulate in the parathyroid gland, where it can suppress PTH secretion.
The main sources of aluminium are the tap water used to prepare the dialysate solution and aluminium containing phosphate binding antacids used to treat uraemic secondary hyperparathyroidism. Fortunately, the reduction in the aluminium content of tap water has seen a reduction in this complication.