| Aluminium toxicity in people on dialysis | |
|---|---|
| Other names | Aluminium toxicity |
| Symptoms | Acute or subacute changes inmental status,proximal muscle weakness,bone pain, numerous nonhealing fractures, and earlyosteoporosis.[1] |
| Causes | High levels of aluminium in water used to preparedialysate.[2] |
| Diagnostic method | Blood aluminium concentrations greater than 100 μg/L.[1] |
| Treatment | Avoiding aluminium exposure;chelation.[1] |
| Medication | Deferoxamine.[1] |
| Frequency | 2.2% amongdialysis patients.[3] |
Aluminium toxicity in people on dialysis is a problem for people onhaemodialysis.Aluminium is often found in unfiltered water used to preparedialysate. 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, andaluminium poisoning may lead to mainly three disorders: aluminium-inducedbone disease,microcytic anemia and neurological dysfunction (encephalopathy). Such conditions are more prominently observed in people withchronic kidney failure and especially in people onhaemodialysis.[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 normalkidney function, serum aluminium is normally lower than 6 microgram/L.[5] Baseline levels of serum aluminium should be <20 microgram/L.[6] According toAAMI, standard aluminium levels in the dialysis fluid should be less than 0.01 milligram/L.[7]
The symptoms of aluminium poisoning tend to be nonspecific. Acute or subacute changes inmental status,proximal muscle weakness,bone pain, numerous nonhealingfractures, and earlyosteoporosis are common presentations in chronic poisoning. Patients may also exhibitdementia,mutism, and convulsions.[1]
Excessive aluminium has been found to causeanemia and has a direct impact onhematopoiesis. Patients with aluminium toxicity have been found to havemicrocytic anemia,anisocytosis,poikilocytosis,chromophilic cells, andbasophilic stippling on theirperipheral smears.[1]
In general, aluminium concentrations in the blood will be less than 10 μg/L, or fewer than 60 μg/L indialysis patients. Toxicity usually occurs at concentrations greater than 100 μg/L.[1] Aluminium levels in the blood, bone, urine, and feces can be measured to confirm aluminium load and toxicosis.[8]
Aluminium toxicity is known to result from high levels of aluminium in water used to preparedialysate; therefore, aluminium levels in water supplies used to preparedialysate must be measured on a regular basis, especially in regions where aluminium is added to the water supply as well as areas with high aluminium concentrations in ground or surface water.[2]
The method used to purify water is determined by specific local concerns and needs.Water softeners remove only a small amount of aluminium,mixed-bed deionization removes aluminium in certain instances, andreverse osmosis is the most effective at removing aluminium.[2]
Aluminium absorption from aluminium-containing gels is the primary source of aluminium buildup indialysis patients in areas with appropriate water treatment. When plasma aluminium levels rise, the dosage of the aluminium-gels should be substantially reduced or discontinued.[2]
Aluminium poisoning is treated by avoiding aluminium exposure and attempting to remove the element from the body's reserves bychelation.[1]
A serum aluminium level of 50-60 μg/L indicates aluminium overload, may correlate withtoxicity, and can be used to initiatechelation therapy in symptomatic individuals. Patients with clinical signs of chronic aluminium toxicity and serum aluminium levels greater than 20 μg/L may also be evaluated for chelation.[1]
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