Aluminium toxicity in people on dialysis

Aluminium toxicity in people on dialysis
Other namesAluminium toxicity
SymptomsAcute or subacute changes in mental status, proximal muscle weakness, bone pain, numerous nonhealing fractures, and early osteoporosis.[1]
CausesHigh levels of aluminium in water used to prepare dialysate.[2]
Diagnostic methodBlood aluminium concentrations greater than 100 mcg/L.[1]
TreatmentAvoiding aluminum exposure and chelation.[1]
MedicationDeferoxamine.[1]
Frequency2.2% among dialysis patients.[3]

Aluminium toxicity in people on dialysis is a problem for people on haemodialysis. Aluminium is often found in unfiltered water used to prepare dialysate. The dialysis process does not efficiently remove excess aluminium from the body, so it may build up over time.[2] Aluminium is a potentially toxic metal, and aluminium poisoning may lead to mainly three disorders: aluminium-induced bone disease, microcytic anemia and neurological dysfunction (encephalopathy). Such conditions are more prominently observed in people with chronic kidney failure and especially in people on haemodialysis.[1]

About 5–10 mg of aluminium enters human body daily through different sources like water, food, occupational exposure to aluminium in industries, and so on.[4] In people with normal kidney function, serum aluminium is normally lower than 6 microgram/L.[5] Baseline levels of serum aluminium should be <20 microgram/L.[6] According to AAMI, standard aluminium levels in the dialysis fluid should be less than 0.01 milligram/L.[7]

  1. ^ a b c d e Bernardo, Jose F (March 24, 2023). "Aluminum Toxicity: Practice Essentials, Pathophysiology, Etiology". Medscape Reference. Retrieved October 2, 2023.
  2. ^ a b Cite error: The named reference Coburn Goodman 1990 pp. 345–367 was invoked but never defined (see the help page).
  3. ^ Chuang, Po-Hsun; Tsai, Kai-Fan; Wang, I-Kuan; Huang, Ya-Ching; Huang, Lan-Mei; Liu, Shou-Hsuan; Weng, Cheng-Hao; Huang, Wen-Hung; Hsu, Ching-Wei; Lee, Wen-Chin; Yen, Tzung-Hai (March 24, 2022). "Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis". International Journal of Environmental Research and Public Health. 19 (7). MDPI AG: 3885. doi:10.3390/ijerph19073885. ISSN 1660-4601. PMC 8997989. PMID 35409569.
  4. ^ AB, Edward RA. Fundamentals of clinical chemistry. 5th ed. Saunders: Harcourt India; 652-3
  5. ^ JR, Mohammad AA. Clinical and forensic applications of capillary electrophoresis. Humana press; 388-9
  6. ^ "Guideline 12. Aluminum Overload and Toxicity in CKD". K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Children With Chronic Kidney Disease (PDF). Vol. 46. National Kidney Foundation. October 2005. p. S70. {{cite book}}: |journal= ignored (help)
  7. ^ "Monitoring Your Dialysis Water Treatment System" (PDF). p. 11. Archived from the original (PDF) on 2020-05-12. Retrieved 2020-05-12.