We studied the in vitro and in vivo characteristics of aluminium (Al) removal by coated charcoal hemoperfusion (HP) in combination with intravenous deferoxamine (DFO). DFO enhanced the clearance of Al by HP in vitro after 180 minutes of perfusion with a solution containing 403.3 ± 14.0 ng/ml of Al at 150 ml/min. The Al clearance was 139 ± 1.0 ml/min with DFO and 49 ± 10.0 ml/min (P < 0.001) without DFO. Addition of DFO enhanced in vitro Al removal from 5.5 ± 0.9 mg to 10.0 ± 1.2 mg (P < 0.05). During our in vivo studies, an HP device was in series in the dialysis circuit after a Cuprophan hemodialyzer. Eight patients with Al toxicity were studied on twelve occasions. Patients received DFO (40 mg/kg) 40 hours before the study. The total Al clearance with the combined hemodialysis (HD) and HP devices was higher than that obtained by the dialyzer alone at 30 minutes (62 ± 4.9 ml/min vs. 25 ± 2.5 ml/min, P < 0.02) and after 180 to 210 minutes (32 ± 3.0 ml/min vs. 19 ± 2.9 ml/min, P < 0.02). After 120 minutes the Al clearance by the HP device alone was significantly lower than the initial Al clearance by HP. Combined HD plus HP removed 2.9 ± 0.4 mg of Al, whereas the total removal of Al by HD alone was 1.5 ± 0.3 mg (P < 0.01).
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