During the past two decades, in association with the commencement of chronic dialysis therapy and prolongation of the uremic state, aluminum toxicity has represented a major cause of morbidity and mortality in uremic patients. The uremic patient has been found to be at higher risk of aluminum loading and toxicity from various sources of parenteral exposure, enhanced gastrointestinal absorption, and compromised ability to eliminate any systemically administered aluminum due to renal impairment. However, the potential sources of aluminum exposure and loading resulting in toxicity in uremic patients have recently been identified. As a result, this toxicity can largely be prevented by eliminating aluminum from the water used to prepare the dialysate, substituting calcium-containing phosphate-binding agents for those containing aluminum, and strict avoidance of the concomitant use of citrate- and aluminum-containing compounds. Thus, in the future, aluminum toxicity should represent a rare and unusual side effect in dialyzed uremic patients.
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