Use of the Deferoxamine Infusion Test in the Diagnosis of Aluminum-Related Osteodystrophy

Abstract

The accumulation of Al in bone can cause disabling osteodystrophy in patients with renal failure. Because the chelating agent deferoxamine can mobilize Al from tissues, the effect of a standard i.v. dose of deferoxamine on plasma Al concentrations in 54 patients on hemodialysis was studied. Stainable bone Al, bone histologic findings and bone Al content were studied. Baseline plasma Al concentrations of > 200 .mu.g/l were associated with Al-related osteodystrophy (specificity, 93%), but concentrations of < 200 .mu.g/l did not exclude the diagnosis (sensitivity, 43%). After administration of deferoxamine, the increase in plasma Al concentration was 534 .+-. 260 (SD) and 214 .+-. 92 .mu.g/l in patients with and without Al-related bone disease, respectively (P < 0.001) and correlated with the bone Al content (r = 0.64). All increment in plasma Al concentration of > 200 .mu.g/l identified 35 of the 37 patients with Al-related osteodystrophy; sensitivity was 94% and specificity, 50%. The deferoxamine infusion test is noninvasive, well tolerated and of value particularly in excluding the diagnosis of Al-related osteodystrophy.