Aluminium toxicity in people on dialysis is a problem for people on

haemodialysis Hemodialysis, also spelled haemodialysis, or simply ''"'dialysis'"'', is a process of filtering the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as c ...

. Aluminium is often found in unfiltered water used to prepare

dialysate In chemistry, dialysis is the process of separating molecules in Solution (chemistry), solution by the difference in their rates of diffusion through a semipermeable membrane, such as dialysis tubing. Dialysis is a common laboratory technique th ...

. The dialysis process does not efficiently remove excess

aluminium Aluminium (or aluminum in North American English) is a chemical element; it has chemical symbol, symbol Al and atomic number 13. It has a density lower than that of other common metals, about one-third that of steel. Aluminium has ...

from the body, so it may build up over time.

Aluminium Aluminium (or aluminum in North American English) is a chemical element; it has chemical symbol, symbol Al and atomic number 13. It has a density lower than that of other common metals, about one-third that of steel. Aluminium has ...

is a potentially toxic metal, and aluminium poisoning may lead to mainly three disorders: aluminium-induced

bone disease Bone disease refers to the medical conditions which affect the bone. Terminology A bone disease is also called an "osteopathy", but because the term osteopathy is often used to refer to an alternative health-care philosophy, use of the term can ...

, microcytic anemia and neurological dysfunction (

encephalopathy Encephalopathy (; ) means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of overall brain dysfunction; this syndrome ...

). Such conditions are more prominently observed in people with

chronic kidney failure Chronic kidney disease (CKD) is a type of long-term kidney disease, defined by the sustained presence of abnormal kidney function and/or abnormal kidney structure. To meet criteria for CKD, the abnormalities must be present for at least three mo ...

and especially in people on

. About 5–10 mg of

enters human body daily through different sources like water, food, occupational exposure to aluminium in industries, and so on. In people with normal

kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...

function, serum

is normally lower than 6 microgram/L. Baseline levels of serum

should be <20 microgram/L. According to

AAMI Australian Associated Motor Insurers Limited (commonly referred to as AAMI) is an Australian general insurance provider offering car, home, CTP and business insurance. AAMI has vehicle assessment centres in Victoria, New South Wales, Queenslan ...

, standard

levels in the dialysis fluid should be less than 0.01 milligram/L.

Signs and symptoms

The symptoms of

poisoning tend to be nonspecific. Acute or subacute changes in

mental status The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in ...

, proximal muscle weakness,

bone pain Bone pain (also known medically by several other names) is pain coming from a bone, and is caused by damaging stimuli. It occurs as a result of a wide range of diseases or physical conditions or both, and may severely impair the quality of life. ...

, numerous nonhealing

fractures Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...

, and early

osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk. It is the most common reason f ...

are common presentations in chronic poisoning. Patients may also exhibit

dementia Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...

mutism In human development, muteness or mutism is defined as an absence of speech, with or without an ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, c ...

, and

convulsions A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term ''convulsion'' is often used as a synony ...

. Excessive

has been found to cause

anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

and has a direct impact on

hematopoiesis Haematopoiesis (; ; also hematopoiesis in American English, sometimes h(a)emopoiesis) is the formation of blood cellular components. All cellular blood components are derived from haematopoietic stem cells. In a healthy adult human, roughly ten ...

. Patients with

toxicity have been found to have microcytic anemia,

anisocytosis Anisocytosis is a medical term meaning that a patient's red blood cells are of unequal size. This is commonly found in anemia and other blood conditions. False diagnostic flagging may be triggered on a complete blood count by an elevated WBC count ...

poikilocytosis Poikilocytosis is variation in the shapes of red blood cells. Poikilocytes may be oval, teardrop-shaped, sickle-shaped or irregularly contracted. Normal red blood cells are round, flattened disks that are thinner in the middle than at the edges. A ...

, chromophilic cells, and basophilic stippling on their peripheral smears.

Diagnosis

In general,

concentrations in the blood will be less than 10 mcg/L, or fewer than 60 mcg/L in

dialysis Dialysis may refer to: * Dialysis (chemistry), a process of separating molecules in solution **Electrodialysis, used to transport salt ions from one solution to another through an ion-exchange membrane under the influence of an applied electric po ...

patients. Toxicity usually occurs at concentrations greater than 100 mcg/L.

levels in the blood, bone, urine, and feces can be measured to confirm

load and toxicosis.

Prevention

toxicity is known to result from high levels of

in water used to prepare

; therefore,

levels in water supplies used to prepare

must be measured on a regular basis, especially in regions where

is added to the water supply as well as areas with high

concentrations in ground or surface water. The method used to purify water is determined by specific local concerns and needs. Water softeners remove only a small amount of

, mixed-bed deionization removes

in certain instances, and

reverse osmosis Reverse osmosis (RO) is a water purification process that uses a partially permeable membrane, semi-permeable membrane to separate water molecules from other substances. RO applies pressure to overcome osmotic pressure that favors even distribu ...

is the most effective at removing

absorption from

-containing gels is the primary source of

buildup in

patients in areas with appropriate water treatment. When plasma

levels rise, the dosage of the

-gels should be substantially reduced or discontinued.

Treatment

poisoning is treated by avoiding

exposure and attempting to remove the element from the body's reserves by

chelation Chelation () is a type of bonding of ions and their molecules to metal ions. It involves the formation or presence of two or more separate coordinate bonds between a polydentate (multiple bonded) ligand and a single central metal atom. These l ...

. A serum

level of 50-60 mcg/L indicates

overload, may correlate with

toxicity Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacteria, bacterium, or plant, as well as the effect o ...

, and can be used to initiate

chelation therapy Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body. Chelation therapy has a long history of use in clinical toxicology and remains in use for some very specific medic ...

in symptomatic individuals. Patients with clinical signs of chronic

toxicity and serum

levels greater than 20 mcg/L may also be evaluated for chelation.

References

{{reflist Aluminium Renal dialysis Toxicology