Increased exposure:
(1) high aluminum level in dialysate fluid for patients being dialyzed
(2) moderate to large doses of aluminum-containing phosphate binders
(3) high aluminum levels in IV fluid
(4) sucralfate and other aluminum containing antacids
(5) significant occupational exposure
Further deterioration in renal function:
(1) diabetes
(2) transplant patient with rejection
Increased intestinal absorption:
(1) gastric pH (low pH for phosphate binding agents; high pH in combination with sucralfate)
(2) oral citrate
(3) breakdown in gastrointestinal absorption barrier (enteropathy, bleeding, etc.)
Other:
(1) low serum PTH level (after parathyroidectomy)
(2) child
