Clinlab Navigator


Aluminum is a ubiquitous trace element. The normal daily intake of aluminum is completely eliminated by glomerular filtration in the kidney. Patients with renal failure have an increased risk of developing aluminum toxicity primarily due to aluminum contaminated water used for dialysis and oral administration of aluminum-based phosphate binder gels. Sustained exposure to aluminum can cause severe encephalopathy, iron refractory microcytic anemia and osteomalacia.

National Kidney Foundation guidelines recommend annual serum aluminum testing of asymptomatic patients undergoing chronic dialysis who do not have other risk factors for aluminum toxicity, such as medications. These guidelines further recommend followup testing to access toxicity whenever the serum concentration is between 60 and 200 ng/mL. This involves performing a baseline aluminum measurement and a second measurement collected 2 days after a 5 mg/kg deferoxamine infusion. A 50 ng/mL incremental rise in serum aluminum after deferoxamine infusion is indicative of aluminum toxicity and the need for treatment.

Prosthetic devices produced by a few companies are composed of aluminum, vanadium, and titanium. Patients with these prostheses are likely to have serum aluminum levels increased above the reference range. 

Serum aluminum concentration is measured by dynamic reaction cell-Inductively coupled plasma-mass spectrometry (DRC-ICP-MS).Serum reference value is 0-6 ng/mL in healthy individuals. The goal for dialysis patients is to keep serum aluminum concentrations below 60 ng/mL.

Blood must be collected in a metal free vacutainer tube. Environmental contamination of specimens with exogenous aluminum during specimen collection or processing may cause falsely elevated results. 


McCarthy JT, Milliner DS, Kurtz SB, et al: Interpretation of serum aluminum values in dialysis patients. Am J Clin Pathol 1986;86:629-636.

Schifman RB and Luevano DR. Aluminum Toxicity. Arch Pathol Lab Med 2018;142:742-46. 

Updated Articles

Fecal Leukocytes

The presence of fecal leukocytes indicates bowel mucosal inflammation, which occurs in invasive bacterial enteritis and ulcerative colitis. The sensitivity of the fecal leukocyte test is approximately 70% for diarrheal disease caused by Shigella,…

New Articles

HIV Drug Resistance

Monogram Biosciences offers both phenotype and genotype assays for HIV antiretroviral drug resistance. Both genotyping and phenotyping technology start out in much the same way. The patient’s viral RNA is isolated, and the section to be tested is…


Updated Lipid…

Treatment of dyslipidemia is the foundation of preventive cardiology. Reduction in low-density lipoprotein (LDL-C) reduces risk of atherosclerotic cardiovascular disease (ASCVD) events in both primary and secondary prevention.The American College of…