Serum ionic fluoride levels in haemodialysis and continuous ambulatory peritoneal dialysis patients

High serum fluoride (F-) in patients with chronic renal failure (CRF) and end-stage renal disease (ESRD) is associated with risk of renal osteodystrophy and other bone changes. This study was done to determine F- in normal healthy controls and patients with ESRD on haemodialysis (HD) or peritoneal dialysis (PD). Seventeen healthy controls (12 males, 5 females) and 39 ESRD patients on dialysis (17 males, 22 females) were recruited in the study in a community with 47.4 +/- 3.28 mu M/1 (range 44-51 mu M/1) of F- content in drinking water. Control subjects showed a mean serum F- concentration of 1.08 +/- 0.350 mu M/1. Males in control group showed slightly higher F- levels (1.15 +/- 0.334, range 0.55-1.9 mu M/1) than females (0.92 +/- 0.370, range 0.6-1.5 mu M/1). Mean serum F- concentration did not correlate significantly with age and sex among control subjects, whereas such correlation was observed in patients with ESRD on dialysis. Mean serum F- concentration was significantly higher in patients on dialysis (2.67 +/- 1.09, range 0.8-5.2 mu M/1) than normal controls. When grouped according to sex, the mean serum F- concentration in males (3.05 +/- 1.04, range 1.8-5.2 mu M/1) was significantly higher than females (2.38 +/- 1.08, range 0.8-5.2 mu M/1). When patients were grouped according to age, it was observed that F- concentration was significantly higher in patients with age groups 21-70 (2.86 +/- 1.05) than those with age group 13-20 years (1.42 +/- 0.531). Thus F- concentration correlated with age and sex, being higher in males and above 20 years. Despite appreciable clearance of F- (39-90%) across the peritoneum, patients on CAPD showed higher serum F- concentration than those on HD (3.1 +/- 1.97 vs 2.5 +/- 1.137 mu M/1). Of the total 39 patients on dialysis 39% had their serum F- concentration above 3.0 mu M/1, posing the risk of renal osteodystrophy. Therefore we recommend frequent monitoring of serum F- concentration in ESRD patients on CAPD/HD, particularly above age 20 years.