Patients with chronic kidney disease (CKD) with a glomerular filtration rate (GFR) less than 30 mL/min/1.73m2 may experience aluminum toxicity from the inability to adequately excrete excess aluminum. Because aluminum is bound to plasma proteins, it is poorly dialyzable. Aluminum accumulates in a variety of tissues that include bone, brain, parathyroid glands as well as other organs. Manifestation of aluminum toxicity can include encephalopathy, osteomalacia, and microcytic anemia developing with iron deficiency.
National Kidney Foundation (NKF). (2003). K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. American Journal of Kidney Diseases, 42 (4, Suppl. 3), S1-S202. Retrieved from: http://www2.kidney.org/professionals/KDOQI/guidelines_bone/Guide11.html