1
|
Chen MY, Ou SH, Chen NC, Yin CH, Chen CL. Aluminum overload in the reverse osmosis dialysis era: does it exist? Ren Fail 2022; 44:1595-1603. [PMID: 36190833 PMCID: PMC9553183 DOI: 10.1080/0886022x.2022.2104165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Aluminum accumulation is a well-described complication in dialysis patients. Improvements in hemodialysis technology have possibly eliminated the occurrence of aluminum overload. Limited evidence suggests that aluminum overload may decline in the era of aluminum removal from dialysis fluids, even with the use of aluminum binders. Methods We examined the data from January 2014 to June 1, 2020, identified through our electronic records, to evaluate the desferrioxamine (DFO) test results for aluminum overload. The presentation and treatment of aluminum overload were recorded. Results Ninety-nine dialysis patients were enrolled for the DFO test. Forty-seven patients (47.5%) were identified as DFO test positive for aluminum overload, of which 14 (14/47) patients had symptoms, including one patient with an unexplained fracture, eight patients with unexplained anemia despite high-dose erythropoiesis-stimulating agents, and five patients with hypercalcemia (serum calcium >11 mg dL-1). None of the patients with aluminum overload developed encephalopathy. Only four of the 47 patients had microcytic anemia. Patients requiring longer treatments (>10 months versus <10 months) had similar basal serum aluminum (p = 0.219) but had an increase in serum aluminum after DFO (p = 0.041). Furthermore, the treatments decreased erythropoietin doses in the aluminum overload group, with serum total alkaline phosphatase levels <60 U L-1 (p = 0.028). Conclusion We concluded that aluminum overload existed in the reverse osmosis dialysis era. In light of non-obvious symptoms, such as anemia and bone turnover change, serum aluminum in dialysis patients should be monitored in countries using aluminum-based phosphate binders, despite reverse osmosis dialysis.
Collapse
Affiliation(s)
- Mei-Yin Chen
- Department of Nutrition and Food Service, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shih-Hsiang Ou
- Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Nai-Ching Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Division of Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Liang Chen
- Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taiwan.,Division of Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institutes of Clinical Medicine, National Yang Ming Chiao Tung University, Taiwan.,Institution of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| |
Collapse
|
2
|
Usmani S, Ahmed N, Gnanasegaran G, Marafi F, van den Wyngaert T. Update on imaging in chronic kidney disease-mineral and bone disorder: promising role of functional imaging. Skeletal Radiol 2022; 51:905-922. [PMID: 34524489 DOI: 10.1007/s00256-021-03905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
Disorders of mineral metabolism and bone disease are common complications in chronic kidney disease (CKD) patients and are associated with increased morbidity and mortality. Bone biopsies, bone scintigraphy, biochemical markers, and plain films have been used to assess bone disorders and bone turnover. Of these, functional imaging is less invasive than bone/marrow sampling, more specific than serum markers and is therefore ideally placed to assess total skeletal metabolism. 18F-sodium fluoride (NaF) PET/CT is an excellent bone-seeking agent superior to conventional bone scan in CKD patients due to its high bone uptake, rapid single-pass extraction, and minimal binding to serum proteins. Due to these properties, 18F-NaF can better assess the skeletal metabolism on primary diagnosis and following treatment in CKD patients. With the increased accessibility of PET scanners, it is likely that PET scanning with bone-specific tracers such as 18F-NaF will be used more regularly for clinical assessment and quantitation of bone kinetics. This article describes the pattern of scintigraphic/functional appearances secondary to musculoskeletal alterations that might occur in patients with CKD.
Collapse
Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Centre, Kuwait City, Kuwait.
| | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK.,Cancer Research Group, Hull York Medical School, University of Hull, York, UK
| | | | - Fahad Marafi
- Jaber Al-Ahmad Molecular Imaging Center, Kuwait City, Kuwait
| | | |
Collapse
|
3
|
Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073885. [PMID: 35409569 PMCID: PMC8997989 DOI: 10.3390/ijerph19073885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Background. This retrospective observational study attempted to examine the prevalence of abnormal blood aluminum levels in dialysis patients, and to explore the association of pathogenic factors, such as demographic, clinical, laboratory as well as the use of phosphate binding drugs, drugs for secondary hyperparathyroidism and erythropoiesis-stimulating drugs with the blood aluminum levels. Methods. The study included 1175 patients (874 hemodialysis and 301 peritoneal dialysis), recruited from Chang Gung Memorial Hospital in November 2020. Patients were stratified into two groups by their blood aluminum levels, as normal (<2 µg/dL, n = 1150) or abnormal (≥2 µg/dL, n = 25). Results. The patients aged 60.4 ± 13.2 years and were dialyzed for 8.6 ± 8.1 years. The average blood aluminum level was 1.0 ± 0.4 µg/dL. Patients with abnormal blood aluminum levels received more sevelamer than patients with normal blood aluminum level (p = 0.014). Patients with abnormal blood aluminum levels had higher platelet count (p = 0.001), triglyceride (p < 0.001) and total iron binding capacity (p = 0.003) than patients with normal blood aluminum levels. Moreover, the cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels (p = 0.003). Conclusions. The prevalence of abnormal blood aluminum levels was low at 2.2%. Nevertheless, the linking of cardiothoracic ratio of more than 0.5 as well as elevated blood platelet count and triglyceride level with blood aluminum levels are interesting, and warranted more researches in this area.
Collapse
|
4
|
Oliveira RBD, Barreto FC, Nunes LA, Custódio MR. Aluminum Intoxication in Chronic Kidney Disease. J Bras Nefrol 2021; 43:660-664. [PMID: 34910802 PMCID: PMC8823919 DOI: 10.1590/2175-8239-jbn-2021-s110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Serviço de Nefrologia, Campinas, SP, Brasil
| | - Fellype Carvalho Barreto
- Universidade Federal do Paraná, Complexo do Hospital de Clínicas, Serviço de Nefrologia, Curitiba, PR, Brasil
| | | | | |
Collapse
|
5
|
Gueiros APS, de Oliveira RA, Carvalho AB. Adynamic bone disease. J Bras Nefrol 2021; 43:650-653. [PMID: 34910800 PMCID: PMC8823915 DOI: 10.1590/2175-8239-jbn-2021-s108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Aluizio Barbosa Carvalho
- Universidade Federal de São Paulo, Department of Medicine, Nephrology Division, São Paulo, SP, Brazil
| |
Collapse
|
6
|
Stanciu GD, Ababei DC, Bild V, Bild W, Paduraru L, Gutu MM, Tamba BI. Renal Contributions in the Pathophysiology and Neuropathological Substrates Shared by Chronic Kidney Disease and Alzheimer's Disease. Brain Sci 2020; 10:brainsci10080563. [PMID: 32824404 PMCID: PMC7464898 DOI: 10.3390/brainsci10080563] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease and Alzheimer’s disease are chronic conditions highly prevalent in elderly communities and societies, and a diagnosis of them is devastating and life changing. Demanding therapies and changes, such as non-compliance, cognitive impairment, and non-cognitive anomalies, may lead to supplementary symptoms and subsequent worsening of well-being and quality of life, impacting the socio-economic status of both patient and family. In recent decades, additional hypotheses have attempted to clarify the connection between these two diseases, multifactorial in their nature, but even so, the mechanisms behind this link are still elusive. In this paper, we sought to highlight the current understanding of the mechanisms for cognitive decline in patients with these concurrent pathologies and provide insight into the relationship between markers related to these disease entities and whether the potential biomarkers for renal function may be used for the diagnosis of Alzheimer’s disease. Exploring detailed knowledge of etiologies, heterogeneity of risk factors, and neuropathological processes associated with these conditions opens opportunities for the development of new therapies and biomarkers to delay or slow their progression and validation of whether the setting of chronic kidney disease could be a potential determinant for cognitive damage in Alzheimer’s disease.
Collapse
Affiliation(s)
- Gabriela Dumitrita Stanciu
- Center for Advanced Research and Development in Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania; (G.D.S.); (B.-I.T.)
| | - Daniela Carmen Ababei
- Pharmacodynamics and Clinical Pharmacy Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
- Correspondence: (D.C.A.); (L.P.)
| | - Veronica Bild
- Pharmacodynamics and Clinical Pharmacy Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Walther Bild
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Luminita Paduraru
- Department Mother & Child Care, Division Neonatology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania
- Correspondence: (D.C.A.); (L.P.)
| | - Mihai Marius Gutu
- Department of Biophysics and Medical Physics-Nuclear Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania;
| | - Bogdan-Ionel Tamba
- Center for Advanced Research and Development in Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania; (G.D.S.); (B.-I.T.)
- Department of Pharmacology, Clinical Pharmacology and Algesiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii street, 700115 Iasi, Romania
| |
Collapse
|
7
|
Carbonara CEM, dos Reis LM, Quadros KRDS, Roza NAV, Sano R, Carvalho AB, Jorgetti V, de Oliveira RB. Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO. J Bras Nefrol 2020; 42:138-146. [PMID: 32756862 PMCID: PMC7427645 DOI: 10.1590/2175-8239-jbn-2019-0045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mineral and bone disorders (MBD) are major complications of chronic kidney disease (CKD)-related adverse outcomes. The Brazilian Registry of Bone Biopsy (REBRABO) is an electronic database that includes renal osteodystrophy (RO) data. We aimed to describe the epidemiological profile of RO in a sample of CKD-MBD Brazilian patients and understand its relationship with outcomes. METHODS Between August 2015 and March 2018, 260 CKD-MBD stage 3-5D patients who underwent bone biopsy were followed for 12 to 30 months. Clinical-demographic, laboratory, and histological data were analyzed. Bone fractures, hospitalizations, and death were considered the primary outcomes. RESULTS Osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, osteomalacia, osteoporosis, and aluminum (Al) accumulation were detected in 85, 43, 27, 10, 77, and 65 patients, respectively. The logistic regression showed that dialysis vintage was an independent predictor of osteoporosis (OR: 1.005; CI: 1.001-1.010; p = 0.01). The multivariate logistic regression revealed that hemodialysis treatment (OR: 11.24; CI: 1.227-100; p = 0.03), previous parathyroidectomy (OR: 4.97; CI: 1.422-17.241; p = 0.01), and female gender (OR: 2.88; CI: 1.080-7.679; p = 0.03) were independent predictors of Al accumulation; 115 patients were followed for 21 ± 5 months. There were 56 hospitalizations, 14 deaths, and 7 fractures during follow-up. The COX regression revealed that none of the variable related to the RO/turnover, mineralization and volume (TMV) classification was an independent predictor of the outcomes. CONCLUSION Hospitalization or death was not influenced by the type of RO, Al accumulation, or TMV classification. An elevated prevalence of osteoporosis and Al accumulation was detected.
Collapse
Affiliation(s)
- Cinthia Esbrile Moraes Carbonara
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Luciene Machado dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil
| | - Kélcia Rosana da Silva Quadros
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Noemi Angelica Vieira Roza
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Rafael Sano
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
| | - Aluizio Barbosa Carvalho
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Vanda Jorgetti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
| | - Rodrigo Bueno de Oliveira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Laboratório para o Estudo do Distúrbio Mineral e Ósseo em Nefrologia, Campinas, SP, Brasil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas, SP, Brasil
- Sociedade Brasileira de Nefrologia, Departamento de Distúrbios do Metabolismo Ósseo Mineral na Doença Renal Crônica, São Paulo, SP, Brasil
| |
Collapse
|
8
|
Chettle DR, McNeill FE. Elemental analysis in living human subjects using biomedical devices. Physiol Meas 2019; 40:12TR01. [PMID: 31816604 DOI: 10.1088/1361-6579/ab6019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Today, patients undergoing dialysis are at low risk for aluminum-induced dementia. Workers are unlikely to experience cadmium-induced emphysema and the public's exposure to lead is an order of magnitude lower than in 1970. The research field of in vivo elemental analysis has played a role in these occupational and environmental health improvements by allowing the effects of people's chronic exposure to elements to be studied using non-invasive, painless, and relatively low-cost technology. From the early 1960s to the present day, researchers have developed radiation-based systems to measure the elemental content of organs at risk or storage organs. This reduces the need for (sometimes painful) biopsy and the risk of infection. Research and development has been undertaken on forty-nine in vivo measurement system designs. Twenty-nine different in vivo elemental analysis systems, measuring 22 different elements, have been successfully taken from design and testing through to human measurement. The majority of these systems employ either neutron activation analysis or x-ray fluorescence analysis as the basis of the measurement. In this review, we discuss eight of the successful systems, explaining the rationale behind their development, the methodology, the health data that has resulted from application of these tools, and provide our opinion on potential future technical developments of these systems. We close by discussing four technologies that may lead to new directions and advances in the whole field.
Collapse
Affiliation(s)
- David R Chettle
- Department of Physics and Astronomy, McMaster University, 1280 Main St West, Hamilton, Ontario, L8S 4M1, Canada
| | | |
Collapse
|
9
|
Hsu CW, Weng CH, Chan MJ, Lin-Tan DT, Yen TH, Huang WH. Association Between Serum Aluminum Level and Uremic Pruritus in Hemodialysis Patients. Sci Rep 2018; 8:17251. [PMID: 30467375 PMCID: PMC6250692 DOI: 10.1038/s41598-018-35217-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/31/2018] [Indexed: 12/17/2022] Open
Abstract
Uremic pruritus (UP) is a common symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is complex. Aluminum (Al) is a common metal and is toxic to patients undergoing HD. Al is also a known human allergen which can induce immune reactions. However, the correlation between Al and UP remains unclear in dialysis patients. A total of 866 patients on maintenance HD were enrolled for analysis. The HD patients with higher serum Al levels had higher a prevalence of UP than those with lower serum Al levels. After adjusting for confounding variables, the serum Al level was significantly associated with UP. Overall, each 10-fold increase in serum Al level was associated with a 5.64-fold increase in the risk of developing UP in these subjects. The results of this cross-sectional study suggest that serum Al level may be associated with the development of UP in patients on maintenance HD.
Collapse
Affiliation(s)
- Ching-Wei Hsu
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Jen Chan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
10
|
Tsai MH, Fang YW, Liou HH, Leu JG, Lin BS. Association of Serum Aluminum Levels with Mortality in Patients on Chronic Hemodialysis. Sci Rep 2018; 8:16729. [PMID: 30425257 PMCID: PMC6233210 DOI: 10.1038/s41598-018-34799-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 08/28/2018] [Indexed: 12/29/2022] Open
Abstract
Despite reported evidence on the relationship between higher serum aluminum levels and poor outcomes in patients on chronic hemodialysis (CHD), the acceptable cutoff value of serum aluminum for mortality remains unclear. A retrospective observational cohort study with 636 Taiwanese patients on CHD was conducted to investigate the impact of serum aluminum levels on mortality. The predictors were bivariate serum aluminum level (<6 and ≥6 ng/mL) and the Outcomes were all-cause and cardiovascular (CV) mortality. During the mean follow-up of 5.3 ± 2.9 years, 253 all-cause and 173 CV deaths occurred. Crude analysis showed that a serum aluminum level of ≥6 ng/mL was a significant predictor of all-cause [hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.40–2.23] and CV (HR, 1.84; 95% CI, 1.36–2.50) mortality. After multivariable adjustment, the serum aluminum level of ≥6 ng/mL remained a significant predictor of all-cause mortality (HR, 1.37, 95% CI, 1.05–1.81) but became insignificant for CV mortality (HR, 1.29; 95% CI, 0.92–1.81). Therefore, our study revealed that a serum aluminum level of ≥6 ng/mL was independently associated with all-cause death in patients on CHD, suggesting that early intervention for aluminum level in patients on CHD might be beneficial even in the absence of overt aluminum toxicity.
Collapse
Affiliation(s)
- Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.,Fu-Jen Catholic University School of Medicine, Taipei, ROC, Taiwan.,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, ROC, Taiwan
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.,Fu-Jen Catholic University School of Medicine, Taipei, ROC, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, ROC, Taiwan
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.,Fu-Jen Catholic University School of Medicine, Taipei, ROC, Taiwan
| | - Bing-Shi Lin
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC, Taiwan.
| |
Collapse
|
11
|
Li Q, Wang D, Qiu J, Peng F, Liu X. Regulating the local pH level of titanium via Mg-Fe layered double hydroxides films for enhanced osteogenesis. Biomater Sci 2018; 6:1227-1237. [PMID: 29589018 DOI: 10.1039/c8bm00100f] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hard tissue implant materials which can cause a suitable alkaline microenvironment are thought to be beneficial for stimulating osteoblast differentiation while suppressing osteoclast generation. To make the local pH around the interface between materials and cells controllable, we prepared a series of Mg-Fe layered double hydroxide (LDH) films on acid-etched pure titanium surfaces via hydrothermal treatment. By adjusting the Mg/Fe proportion ratio, the interlayer spacing of Mg-Fe LDHs was regulated, making their OH- exchange abilities adjustable, and this ultimately resulted in a microenvironment with a controllable pH value. In vitro experiments demonstrated that the Mg-Fe LDH film-modified titanium surface possessed good biocompatibility and osteogenic activity, especially the Mg-Fe LDH film with Mg/Fe proportion ratio of 4, which could form a suitable alkaline microenvironment for the growth and osteogenetic differentiation of stem cells. These results demonstrate the potential application of the prepared Mg-Fe LDH films in enhancing the osteogenesis of implant materials while providing a new way into the design of controllable alkaline environment.
Collapse
Affiliation(s)
- Qianwen Li
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China.
| | | | | | | | | |
Collapse
|
12
|
Schifman RB, Luevano DR. Aluminum Toxicity: Evaluation of 16-Year Trend Among 14 919 Patients and 45 480 Results. Arch Pathol Lab Med 2018; 142:742-746. [PMID: 29509029 DOI: 10.5858/arpa.2017-0049-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Annual monitoring with serum aluminum measurements is recommended for dialysis patients who are susceptible to toxic accumulation from contaminated dialysis fluid or from ingestion of aluminum-containing medications. OBJECTIVE - To evaluate long-term trends in serum aluminum concentrations and frequency of chronic toxicity. DESIGN - A retrospective observational study was conducted by analyzing serum aluminum results obtained from the Veterans Affairs corporate data warehouse. Serum aluminum concentrations of 60 μg/L or greater were considered false positives and not indicative of chronic toxicity if another specimen retested within 45 days had a concentration below 20 μg/L. RESULTS - A total of 45 480 serum aluminum results involving 14 919 patients and 119 Veteran Affairs facilities during a 16-year period ending in October 2016 were evaluated. The percentage of elevated (≥20 μg/L) serum aluminum results declined from 31.5% in 2000 to 2.0% in 2015. Average testing intervals changed from every 159 days in 2000 to every 238 days in 2015. Of 529 patients with serum aluminum concentrations of 60 μg/L or greater, 216 (40.8%) were retested within 45 days (average = 21 days); of these, 83 (38.4%) had concentrations below 20 μg/L after repeated measurements. Retesting rates increased with higher initial serum aluminum concentrations. CONCLUSIONS - Aluminum toxicity, as assessed by serum levels, has substantially declined over time and is now rare. Many serum aluminum concentrations in the toxic range were not confirmed after retesting. Patients with toxic serum aluminum concentrations should be retested with another specimen before undergoing treatment or investigating sources of exposure to verify abnormal results.
Collapse
Affiliation(s)
| | - Daniel R Luevano
- From the Departments of Diagnostics (Dr Schifman) and Pathology and Laboratory Medicine (Mr Luevano), Southern Arizona VA Healthcare System, Tucson; and the Department of Pathology, University of Arizona, Tucson (Dr Schifman)
| |
Collapse
|
13
|
Seidowsky A, Dupuis E, Drueke T, Dard S, Massy ZA, Canaud B. Intoxication aluminique en hémodialyse chronique. Un diagnostic rarement évoqué de nos jours. Illustration par un cas clinique et revue de la littérature. Nephrol Ther 2018; 14:35-41. [DOI: 10.1016/j.nephro.2017.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 11/28/2022]
|
14
|
Wang TL, Fang YW, Leu JG, Tsai MH. Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis. PLoS One 2017; 12:e0190008. [PMID: 29261793 PMCID: PMC5738104 DOI: 10.1371/journal.pone.0190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6–2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52–3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63–3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28–2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.
Collapse
Affiliation(s)
- Tzu-Lin Wang
- Division of Cardiology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C
| | - Ming-Hsien Tsai
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.,Fu-Jen Catholic University School of Medicine, Taipei, Taiwan, R.O.C.,Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
| |
Collapse
|
15
|
Susantitaphong P, Tiranathanagul K, Katavetin P, Praditpornsilpa K, De Broe ME, D’Haesec PC, Eiam-Ong S. Effect of aluminum on markers of bone formation resorption in chronic hemodialysis patients. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0804.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: T`he prevalence of aluminum (Al)-related toxicity in hemodialysis (HD) patients has declined. However, some HD patients continue to receive Al-based phosphate binders, in part because of the expense of Al-free binders.
Objective: To explore the effect of Al-based binders and their discontinuation on iron status, and markers of bone formation resorption in HD patients.
Methods: Following an initial screen of serum Al levels in 37 HD patients, a second screening was performed after discontinuation of Al-based binders in a 2-year follow-up. A desferrioxamine (DFO; 5 mg/kg) test, and assessment of iron status and bone markers were conducted in the second screening.
Results: Mean serum Al level was initially 27.8 ± 10.3 μg/L. Thirteen patients had a serum Al >30 μg/L, a level considered possibly toxic. There was a positive correlation between serum Al levels, HD duration, and cumulative dose of Al-based binder. At the second screening, the mean serum Al level decreased to 12.5 ± 7.4 μg/L. The mean serum Al level increased to 26.0 ± 14.7 μg/L post-DFO, but in none of the patients did the change in serum Al exceed the 50 μg/L threshold associated with Al-induced bone disease. The decrease in serum Al level was associated with a significant increase in intact parathyroid hormone (iPTH) whereas total alkaline phosphatase did not change.
Conclusions: We recommend that if Al-based phosphate binders are used in HD patients, serum Al level, iron, and markers of bone formation resorption be closely monitored to ensure safe use of these drugs.
Collapse
Affiliation(s)
- Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Extracorporeal Multiorgan Support Dialysis Center, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Marc E. De Broe
- Laboratory of Pathophysiology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences,University of Antwerp, Wilrijk 2610, Belgium
| | - Patrick C. D’Haesec
- Laboratory of Pathophysiology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Wilrijk 2610, Belgium
| | - Somchai Eiam-Ong
- MD, Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand
| |
Collapse
|
16
|
Susnea I, Weiskirchen R. Trace metal imaging in diagnostic of hepatic metal disease. MASS SPECTROMETRY REVIEWS 2016; 35:666-686. [PMID: 25677057 DOI: 10.1002/mas.21454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 06/04/2023]
Abstract
The liver is the most central organ and the largest gland of the body that influences and controls a variety of metabolic and catabolic processes. It produces inconceivable many essential proteins, is responsible for the recovery of various food components, degrades toxins, mediates the bile production, and is involved in the excretion of unwanted metabolites. Several of these anabolic or catabolic functions of the liver depend on trace elements. These are either integral part of enzymes, cofactors, or act as chemical catalysts. Therefore, a lack of trace elements can lead to organ failure or systemic illness. Conversely, excessive hepatic trace element deposition resulting from genetic disorders, intoxication, extensive dietary supply, or long-term parenteral nutrition may cause hepatic inflammation, fibrosis, cirrhosis, and even hepatocellular carcinoma. Although specific serum parameters currently allow rough assessment of metal deficit and excess, the precise quantification of hepatic metal content in liver is presently only possible by different titration or staining techniques of biopsy specimens. Recently, novel innovative metal imaging techniques were developed that are on the way to replace these traditional methods. In the present review, we summarize the function of different trace elements in liver health and disease and discuss the present knowledge on how quantitative biometal imaging techniques such as synchrotron X-ray fluorescence microscopy, secondary ion mass spectrometry, and laser ablation inductively coupled plasma mass spectrometry enrich diagnostics in the detection and quantification of hepatic metal disorders. We will further discuss sample preparation, sensitivity, spatial resolution, specificity, quantification strategies, and potential future applications of metal bioimaging in experimental research and clinical daily routine. © 2015 Wiley Periodicals, Inc. Mass Spec Rev 35:666-686, 2016.
Collapse
Affiliation(s)
- Iuliana Susnea
- Central Institute of Engineering, Electronics and Analytics (ZEA-3), Forschungszentrum Jülich, D-52425, Jülich, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH University Hospital Aachen, D-52074, Aachen, Germany.
| |
Collapse
|
17
|
Hsu CW, Weng CH, Lee CC, Lin-Tan DT, Chen KH, Yen TH, Huang WH. Association of low serum aluminum level with mortality in hemodialysis patients. Ther Clin Risk Manag 2016; 12:1417-1424. [PMID: 27695338 PMCID: PMC5028174 DOI: 10.2147/tcrm.s113829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The National Kidney Foundation–Kidney Disease Outcomes Quality Initiative recommends that the serum aluminum level (SAL) should be below 20 µg/L for patients with maintenance hemodialysis (MHD). However, serum aluminum may have toxic effects on MHD patients even when it is in the apparently acceptable range (below 20 µg/L). Methods The Medical Ethics Committee approved this study. Initially, 954 MHD patients in dialysis centers were recruited. A total of 901 patients met the inclusion criteria and were followed-up for 1 year. Patients were stratified by SAL into four equal-sized groups: first quartile (<6 µg/L), second quartile (6–9 µg/L), third quartile (9–13 µg/L), and fourth quartile (>13 µg/L). Demographic, biochemical, and dialysis-related data were obtained for analyses. A linear regression model was applied to identify factors associated with SAL. Cox proportional hazard model was used to determine the significance of variables in prediction of mortality. Results Only 9.3% of MHD patients had SALs of 20 µg/L or more. At the end of the follow-up, 54 patients (6%) died, and the main cause of death was cardiovascular disease. Kaplan–Meier survival analysis showed that patients in the fourth SAL quartile had higher mortality than those in the first SAL quartile (log rank test, χ2=13.47, P=0.004). Using the first quartile as reference, Cox multivariate analysis indicated that patients in the third quartile (hazard ratio =1.31, 95% confidence interval =1.12–1.53, P=0.038) and the fourth quartile (hazard ratio =3.19, 95% confidence interval =1.08–8.62, P=0.048) had increased risk of all-cause mortality. Conclusion This study demonstrates that SAL, even when in an apparently acceptable range (below 20 µg/L), is associated with increased mortality in MHD patients. The findings suggest that avoiding exposure of aluminum as much as possible is warranted for MHD patients.
Collapse
Affiliation(s)
- Ching-Wei Hsu
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hao Weng
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Cheng-Chia Lee
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Dan-Tzu Lin-Tan
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Kuan-Hsing Chen
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Tzung-Hai Yen
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Wen-Hung Huang
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| |
Collapse
|
18
|
Li P, Luo W, Zhang H, Zheng X, Liu C, Ouyang H. Effects of Aluminum Exposure on the Bone Stimulatory Growth Factors in Rats. Biol Trace Elem Res 2016; 172:166-171. [PMID: 26594034 DOI: 10.1007/s12011-015-0569-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/17/2015] [Indexed: 12/21/2022]
Abstract
Aluminum (Al) is considered to be a potentially toxic metal and inhibits bone formation. Transforming growth factor β1 (TGF-β1) and bone morphogenetic protein 2 (BMP-2) play an important role in regulating the bone formation. Therefore, this study aimed to investigate the effects of Al on the TGF-β1 and BMP-2 in rats. In this study, Wistar rats were randomly divided into Al-treated group and control group. The Al-treated rats were provided with drinking water containing 100 mg/L AlCl3, and the control rats were given distilled water for 30, 60, and 90 days, respectively. Ten rats were sacrificed in each group every 30 days. The Al-treated rats showed lower body weight and higher serum and bone levels of Al compared with the control rats. The expression levels of TGF-β1 and BMP-2 were also significantly decreased in the Al-treated rats. Serum levels of bone gamma-carboxyglutamic acid protein (BGP), carboxy-terminal propeptide of type I procollagen (PICP), and bone alkaline phosphatase (B-ALP) were markedly lower in the Al-treated groups than in the control group. These results indicate that Al inhibits the expression of TGF-β1 and BMP-2 in bone, which inhibits the activity of osteoblasts and reduces the synthesis of BGP, B-ALP, and type I collagen, thereby inhibiting bone formation.
Collapse
Affiliation(s)
- Peng Li
- College of Animal Science, Jilin University, 5333 Xi'an Road, Changchun, Jilin, 130062, China
- College of Pharmaceutical Engineering, Jilin Agriculture Science and Technology College, Jilin City, 132000, China
| | - Weiwei Luo
- College of Animal Science, Jilin University, 5333 Xi'an Road, Changchun, Jilin, 130062, China
| | - Hui Zhang
- College of Pharmaceutical Engineering, Jilin Agriculture Science and Technology College, Jilin City, 132000, China
| | - Xue Zheng
- College of Animal Science, Jilin University, 5333 Xi'an Road, Changchun, Jilin, 130062, China
- College of Pharmaceutical Engineering, Jilin Agriculture Science and Technology College, Jilin City, 132000, China
| | - Chao Liu
- College of Pharmaceutical Engineering, Jilin Agriculture Science and Technology College, Jilin City, 132000, China
| | - Hongsheng Ouyang
- College of Animal Science, Jilin University, 5333 Xi'an Road, Changchun, Jilin, 130062, China.
| |
Collapse
|
19
|
Skarabahatava AS, Lukyanenko LM, Slobozhanina EI, Falcioni ML, Orlando P, Silvestri S, Tiano L, Falcioni G. Plasma and mitochondrial membrane perturbation induced by aluminum in human peripheral blood lymphocytes. J Trace Elem Med Biol 2015; 31:37-44. [PMID: 26004890 DOI: 10.1016/j.jtemb.2015.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 01/31/2023]
Abstract
Aluminum is a redox-inert element that could induce cell damage via activation of oxidative stress. In this work, the effect of aluminum on different cellular compartments of human peripheral blood lymphocytes was studied. The presence of aluminum induced a lipid peroxidation and physico-chemical modifications at the membrane level. A decrease in fluorescence anisotropy of TMA-DPH and in the polarity of the lipid bilayer with a concomitant shift toward a gel phase was observed, while the pyrene excimerization coefficient (Kex) increased. Flow cytometry measurements, using JC-1, Rhodamine 123 and H2-DCFDA as fluorescent probes, indicated that aluminum induces a slight mitochondrial membrane depolarization that was associated with a moderate increase in reactive oxygen species production. A significative influence on these parameters was measured only at high aluminum concentration.
Collapse
Affiliation(s)
| | | | | | | | - Patrick Orlando
- Department of Clinical Dental Sciences, Polytechnic University of Marche, via Ranieri 60131, Ancona, Italy
| | - Sonia Silvestri
- Department of Clinical Dental Sciences, Polytechnic University of Marche, via Ranieri 60131, Ancona, Italy
| | - Luca Tiano
- Department of Clinical Dental Sciences, Polytechnic University of Marche, via Ranieri 60131, Ancona, Italy.
| | | |
Collapse
|
20
|
Zuckier LS, Martineau P. Altered Biodistribution of Radiopharmaceuticals Used in Bone Scintigraphy. Semin Nucl Med 2015; 45:81-96. [DOI: 10.1053/j.semnuclmed.2014.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
21
|
Sharma AK, Toussaint ND, Pickering J, Beeston T, Smith ER, Holt SG. Assessing the utility of testing aluminum levels in dialysis patients. Hemodial Int 2014; 19:256-62. [PMID: 25306885 DOI: 10.1111/hdi.12231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Plasma aluminum (Al) is routinely tested in many dialysis patients. Aluminum exposure may lead to acute toxicity and levels in excess of ∼2.2 μmol/L (60 μg/L) should be avoided. Historically, toxicity has been caused by excessive dialyzate Al but modern reverse osmosis (RO) water should be Al free. Nevertheless, many units continue to perform routine Al levels on dialysis patients. This single-center study retrospectively analyzed Al levels in plasma, raw water feed, and RO product between 2010 and 2013 using our database (Nephworks 6) with the aim of determining the utility of these measurements. Two thousand fifty-eight plasma Al tests in 755 patients (61.9% male, mean age 64.7 years) were reviewed showing mean ± SD of 0.41 ± 0.30 μmol/L. One hundred eleven (5.4%) tests from 61 patients had Al levels >0.74 μmol/L and 45 (73.8%) of these patients were or had been prescribed Al hydroxide (Al(OH)(3)) as a phosphate binder. Seven patients had Al concentrations >2.2 μmol/L with no source of Al identified in 1 patient. One hundred sixty-six patients taking Al(OH)(3) (78.7% of all patients on Al(OH)(3)) had levels ≤0.74 μmol/L, the odds ratio of plasma Al > 0.74 μmol/L on Al(OH)3 was 9. The cost of plasma Al assay is $A30.60; thus, costs were $A62,974.80 over the study period. Despite RO feed water Al levels as high as 48 μmol/L, Al output from the RO was almost always undetectable (<0.1 μmol/L) with dialyzate Al levels > 2.2 μmol/L only 3 times since 2010, and never in the last 3 years. Routine unselected testing of plasma Al appears unnecessary and expensive and more selective testing in dialysis patients should be considered.
Collapse
Affiliation(s)
- Ashish K Sharma
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
22
|
Huang WF, Chou HC, Tsai YW, Hsiao FY. Safety of deferasirox: a retrospective cohort study on the risks of gastrointestinal, liver and renal events. Pharmacoepidemiol Drug Saf 2014; 23:1176-82. [PMID: 24946110 DOI: 10.1002/pds.3657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Deferasirox (DFX) is an effective and well-tolerated oral iron chelator elevating the adherence to iron chelating therapy among patients with iron overload. However, the US Food and Drug Administration issued a warning about the potential adverse events associated with DFX in 2010. METHODS To examine the risks of gastrointestinal (GI) bleeding, acute liver necrosis, and acute renal failure among DFX users compared with desferrioxamine (DFO) users in a real-world setting, first-time users of DFX or DFO between 2005 and 2008 in Taiwan's National Health Insurance database were observed in this population-based retrospective cohort study. The risks of different adverse events were individually analyzed by Cox proportional hazards models and adjusted by age, sex, concomitant medications, and prior medical conditions. RESULTS Deferasirox users had the highest incidence rates of GI bleeding (2.03 per 10 000 patient-days), acute liver necrosis (0.26 per 10 000 patient-days) and acute renal failure (1.45 per 10 000 patient-days) compared with other iron chelator users. Compared with DFO users, DFX users were not associated with the risk of GI bleeding (adjusted HR 1.03, 95% CI 0.61-1.74, p = 0.90) and the risk of acute liver necrosis (adjusted HR 2.13, 95% CI 0.49-9.33, p = 0.32). The association between DFX use and acute renal failure was found to be statistically significant (HR 2.18, 95% CI 1.18-4.02, p = 0.01; adjusted HR 2.41, 95% CI 1.27-4.58, p = 0.01). CONCLUSION In this study, we found statistically significant higher risk of acute renal failure and non-statistically significant higher risk of GI bleeding and acute liver necrosis associated with DFX use. More researches are warranted to evaluate the association between DFX use and potential adverse events.
Collapse
Affiliation(s)
- Weng-Foung Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; Center for Health and Welfare Policy Research, National Yang-Ming University, Taipei, Taiwan
| | | | | | | |
Collapse
|
23
|
Mardini J, Lavergne V, Ghannoum M. Aluminum transfer during dialysis: a systematic review. Int Urol Nephrol 2014; 46:1361-5. [PMID: 24938693 DOI: 10.1007/s11255-014-0752-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Dialysis-dependent patients are particularly susceptible to the toxic effects of aluminum (Al) because of their impaired ability to eliminate it. Al contamination of dialysis fluid remains a threat in this population. The mechanism for Al diffusion across dialysis membranes is not well established. Our objective is to verify, in AL-exposed patients, the postulate that the direction of Al transfer is predicted by the concentration gradient between free diffusible plasma Al and dialysate Al. METHODS A systematic review of the literature was performed. Only papers which included Al plasma concentration ([Al]p), Al dialysate concentration ([Al]d) and direction of Al transfer (positive = from dialysate to plasma, negative = from plasma to dialysate) were selected. We also included four patients from our own cohort. Assuming that [Al]p has an ultrafiltrable fraction between 17 and 23%, cases were considered in keeping with our hypothesis if any of the following scenarios was present: negative Al transfer when [Al]d < [Al]p*23% and positive Al transfer when [Al]d > [Al]p*17%. RESULTS The search yielded 409 articles, of which 12 were selected for review. When reviewing individual patients for analysis, 108 out of 115 (94%) patients followed our hypothesis. By further excluding cases in which Al transfer could not be determined, only three out of 111 patients were contrary to out hypothesis. CONCLUSION Comparing ultrafiltrable Al to dialysate Al permits to accurately predict the direction of Al transfer. The optimal [Al]d should be <20% of the maximally acceptable [Al]p. In order to follow K/DOQI guidelines ([Al]p < 20 μg/L), the [Al]d should therefore not exceed 4 μg/L. At the level presently supported by K/DOQI ([Al]d < 10 μg/L), [Al]p could realistically reach 50 μg/L and potentially cause toxicity.
Collapse
Affiliation(s)
- Joëlle Mardini
- Nephrology Department, Verdun Hospital, University of Montreal, 4000 Lasalle Blvd, Montreal, QC, Canada
| | | | | |
Collapse
|
24
|
A case of recurrent renal aluminum hydroxide stone. Case Rep Urol 2014; 2014:212314. [PMID: 25013740 PMCID: PMC4070326 DOI: 10.1155/2014/212314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022] Open
Abstract
Renal stone disease is characterized by the differences depending on the age, gender, and the geographic location of the patients. Seventy-five percent of the renal stone components is the calcium (Ca). The most common type of the stones is the Ca oxalate stones, while Ca phosphate, uric acid, struvite, and sistine stones are more rarely reported. Other than these types, triamterene, adenosine, silica, indinavir, and ephedrine stones are also reported in the literature as case reports. However, to the best of our knowledge, aluminum hydroxide stones was not reported reported before. Herein we will report a 38-years-old woman with the history of recurrent renal colic disease whose renal stone was determined as aluminum hydroxide stone in type. Aluminum mineral may be considered in the formation of kidney stones as it is widely used in the field of healthcare and cosmetics.
Collapse
|
25
|
Serum aluminum levels in dialysis patients after sclerotherapy of internal hemorrhoids with aluminum potassium sulfate and tannic acid. Surg Today 2014; 44:2314-7. [PMID: 24817127 DOI: 10.1007/s00595-014-0914-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for internal hemorrhoids. However, it is contraindicated for patients with chronic renal failure on dialysis, because the aluminum in ALTA can cause aluminum encephalopathy when it is not excreted effectively. We conducted this study to measure the serum aluminum concentrations and observe for symptoms relating to aluminum encephalopathy in dialysis patients after ALTA therapy. METHODS Ten dialysis patients underwent ALTA therapy for hemorrhoids. We measured their serum aluminum concentrations and observed them for possible symptoms of aluminum encephalopathy. RESULTS The total injection volume of ALTA solution was 31 mL (24-37). The median serum aluminum concentration before ALTA therapy was 9 μg/L, which increased to 741, 377, and 103 μg/L, respectively, 1 h, 1 day, and 1 week after ALTA therapy. These levels decreased rapidly, to 33 μg/L by 1 month and 11 μg/L by 3 months after ALTA therapy. No patient suffered symptoms related to aluminum encephalopathy. CONCLUSIONS Although the aluminum concentrations increased temporarily after ALTA therapy, dialysis patients with levels below 150 μg/L by 1 week and thereafter are considered to be at low risk of the development of aluminum encephalopathy.
Collapse
|
26
|
Neurologic complications of acute and chronic renal disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:383-93. [PMID: 24365307 DOI: 10.1016/b978-0-7020-4086-3.00024-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is an increasing incidence and prevalence of patients with chronic kidney disease (CKD) in Western industrialized countries and currently is estimated at approximately 10% of adults aged over 20 years. Renal failure causes an excessively increased risk of cerebrovascular and cardiovascular complications. Moreover, renal failure leads to a number of the neurologic symptoms neurologists are often confronted with. This chapter gives an overview of possible neurologic complications of acute renal failure and CKD. Complications of the central nervous system (e.g., uremic encephalopathy, disequilibrium syndrome, and drug induced disorders) are reviewed. It has long been known that uremia leads to peripheral nerve injury. Frequent neurological diseases such as uremic polyneuropathy, autonomic neuropathy, and a range of mononeuropathies are discussed.
Collapse
|
27
|
Postnatal toxic and acquired disorders. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 23622416 DOI: 10.1016/b978-0-444-59565-2.00063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
To develop and function optimally, the brain requires a balanced environment of electrolytes, amino acids, neurotransmitters, and metabolic substrates. As a consequence, organ dysfunction has the potential to induce brain disorders and toxic-metabolic encephalopathies, particularly when occurring during early stages of cerebral maturation. Induced toxicity of three different organ systems that are commonly associated with brain complications are discussed. First, thyroid hormone deficiency caused by intrinsic or extrinsic factors (e.g., environmental toxins) may induce severe adverse effects on child neurological development from reversible impairments to permanent mental retardation. Second, inadequate removal of wastes due to chronic renal failure leads to the accumulation of endogenous toxins that are harmful to brain function. In uremic pediatric patients, the brain becomes more vulnerable to exogenous substances such as aluminum, which can induce aluminum encephalopathy. Following surgical procedures, neurological troubles including focal defects and severe epileptic seizures may result from hypertensive encephalopathy combined with toxicity of immunomodulating substances, or from the delayed consequences of cardiovascular defect. Taken together, this illustrates that organ disorders clearly have an impact on child brain function in various ways.
Collapse
|
28
|
Lukyanenko LM, Skarabahatava AS, Slobozhanina EI, Kovaliova SA, Falcioni ML, Falcioni G. In vitro effect of AlCl3 on human erythrocytes: changes in membrane morphology and functionality. J Trace Elem Med Biol 2013. [PMID: 23199702 DOI: 10.1016/j.jtemb.2012.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aluminum belongs to a group of potential toxic elements capable of penetrating the human body. In this paper, the effect of aluminum concentrations on red blood cell membranes using different fluorescent probes able to localize in various parts of the phospholipid bilayer (TMA-DPH, laurdan and pyrene) were studied. Our results confirm that human erythrocytes exposed to aluminum undergo physico-chemical modifications at the membrane level. A decrease in fluorescence anisotropy of TMA-DPH and in the polarity of the lipid bilayer with a concomitant shift toward a gel phase was observed, and the pyrene excimerization coefficient (kex) increased. Furthermore, the presence of aluminum induced lipid peroxidation and reduced the activity of erythrocyte antioxidant enzymes (SOD, CAT and GSHPx). Al-induced morphological changes on the erythrocyte membrane surface were monitored using atomic force microscopy. These results provide further information on the target of action of different aluminum amounts.
Collapse
|
29
|
Malaki M. Acute encephalopathy following the use of aluminum hydroxide in a boy affected with chronic kidney disease. J Pediatr Neurosci 2013; 8:81-2. [PMID: 23772257 PMCID: PMC3680909 DOI: 10.4103/1817-1745.111439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Majid Malaki
- Nephrology Department, Pediatric Health Research Center, Tabriz Children Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
30
|
Suppressive effects of aluminum trichloride on the T lymphocyte immune function of rats. Food Chem Toxicol 2011; 50:532-5. [PMID: 22198605 DOI: 10.1016/j.fct.2011.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/19/2011] [Accepted: 12/07/2011] [Indexed: 11/21/2022]
Abstract
Aluminum (Al) has increasingly been used in the daily life, and could cause the change of human health because it can accumulate in the organs. A rat model was thus used to examine potential effect of Al on the immune function. Forty male Wistar rats (5 weeks old) weighed 110-120 g were randomly allocated into four groups and were orally exposed to 0, 64.18, 128.36, and 256.72 mg/kg body weight aluminum trichloride (AlCl3) in drinking water for 120 days. The levels of CD3+, CD4+, CD8+ T lymphocyte, acid non-specific activity esterase (ANAE+) in blood, and interleukin-2 (IL-2) and tumor necrosis factor-α (TNF-α) in serum were determined at the end of experiment. The results showed that the proportions of CD3+, CD4+ T lymphocyte, the ratio of CD4+/CD8+, and the levels of ANAE+, IL-2, and TNF-α were significantly reduced in AlCl3-treated rats, while the proportion of CD8+ T lymphocyte was increased in an AlCl3-dose dependent manner. Our findings indicate that a long term exposure of AlCl3 could suppress the T lymphocyte immune function of rats.
Collapse
|
31
|
|
32
|
Christie M, Lavergne V, Sikaneta T, Hue CS, Taskapan H, Tam PW, Ayoub P, Ting R, Leblanc D, Ghannoum M. Hyperaluminemia during long-term dialysis: still relevant today. Am J Kidney Dis 2011; 58:861-3. [PMID: 21937158 DOI: 10.1053/j.ajkd.2011.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 08/04/2011] [Indexed: 11/11/2022]
|
33
|
Hutchison AJ, Smith CP, Brenchley PEC. Pharmacology, efficacy and safety of oral phosphate binders. Nat Rev Nephrol 2011; 7:578-89. [DOI: 10.1038/nrneph.2011.112] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
34
|
Lemire J, Appanna VD. Aluminum toxicity and astrocyte dysfunction: a metabolic link to neurological disorders. J Inorg Biochem 2011; 105:1513-7. [PMID: 22099161 DOI: 10.1016/j.jinorgbio.2011.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 06/21/2011] [Accepted: 07/08/2011] [Indexed: 12/21/2022]
Abstract
Aluminum (Al) has been implicated in a variety of neurological diseases. However, the molecular mechanisms that enable Al to be involved in these disorders have yet to be fully delineated. Using astrocytes as a model of the cerebral cellular system, we have uncovered the biochemical networks that are affected by Al toxicity. In this review, we reveal how the inhibitory influence of Al on ATP production and on mitochondrial functions help generate globular astrocytes that are fat producing machines. These biological events may be the contributing factors to Al-triggered brain disorders.
Collapse
Affiliation(s)
- Joseph Lemire
- Department of Chemistry and Biochemistry, Laurentian University, Sudbury, Ontario, Canada P3E 2C6
| | | |
Collapse
|
35
|
Mailloux RJ, Lemire J, Appanna VD. Hepatic response to aluminum toxicity: dyslipidemia and liver diseases. Exp Cell Res 2011; 317:2231-8. [PMID: 21787768 DOI: 10.1016/j.yexcr.2011.07.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/08/2011] [Accepted: 07/09/2011] [Indexed: 10/17/2022]
Abstract
Aluminum (Al) is a metal toxin that has been implicated in the etiology of a number of diseases including Alzheimer's, Parkinson's, dialysis encephalopathy, and osteomalacia. Al has been shown to exert its effects by disrupting lipid membrane fluidity, perturbing iron (Fe), magnesium, and calcium homeostasis, and causing oxidative stress. However, the exact molecular targets of aluminum's toxicity have remained elusive. In the present review, we describe how the use of a systems biology approach in cultured hepatoblastoma cells (HepG2) allowed the identification of the molecular targets of Al toxicity. Mitochondrial metabolism is the main site of the toxicological action of Al. Fe-dependent and redox sensitive enzymes in the tricarboxylic acid (TCA) cycle and oxidative phosphorylation (OXPHOS) are dramatically decreased by Al exposure. In an effort to compensate for diminished mitochondrial function, Al-treated cells stabilize hypoxia inducible factor-1α (HIF-1α) to increase ATP production by glycolysis. Additionally, Al toxicity leads to an increase in intracellular lipid accumulation due to enhanced lipogenesis and a decrease in the β-oxidation of fatty acids. Central to these effects is the alteration of α-ketoglutarate (KG) homeostasis. In Al-exposed cells, KG is preferentially used to quench ROS leading to succinate accumulation and HIF-1α stabilization. Moreover, the channeling of KG to combat oxidative stress leads to a reduction of l-carnitine biosynthesis and a concomitant decrease in fatty acid oxidation. The fluidity and interaction of these metabolic modules and the implications of these findings in liver-related disorders are discussed herein.
Collapse
Affiliation(s)
- Ryan J Mailloux
- Laurentian University, Department of Chemistry and Biochemistry, Canada
| | | | | |
Collapse
|
36
|
Abstract
The kidneys are famously responsible for maintaining external balance of prevalent minerals, such as sodium, chloride, and potassium. The kidney's role in handling trace minerals is more obscure to most nephrologists. Similarly, the impact of kidney failure on trace mineral metabolism is difficult to anticipate. The associated dietary modifications and dialysis create the potential for trace mineral deficiencies and intoxications. Indeed, there are numerous reports of dialysis-associated mishaps causing mineral intoxication, notable for the challenge of assigning causation. Equally challenging has been the recognition of mineral deficiency syndromes, amid what is often a cacophony of multiple comorbidities that vie for the attention of clinicians who care for patients with chronic kidney disease. In this paper, I review a variety of minerals, some of which are required for maintenance of normal human physiology (the U.S. Food and Drug Administration's list of essential minerals), and some that have attracted attention in the care of dialysis patients. For each mineral, I will discuss its role in normal physiology and will review reported deficiency and toxicity states. I will point out the interesting inter-relationships between several of the elements. Finally, I will address the special concerns of aluminum and magnesium as they pertain to the dialysis population.
Collapse
Affiliation(s)
- Richard K Kasama
- Division of Nephrology, UMDNJ-Robert Wood Johnson Medical School, Cooper University Hospital, Camden, New Jersey 08103 , USA.
| |
Collapse
|
37
|
Mudge DW, Johnson DW, Hawley CM, Campbell SB, Isbel NM, van Eps CL, Petrie JJB. Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice? BMC Nephrol 2011; 12:20. [PMID: 21569446 PMCID: PMC3107169 DOI: 10.1186/1471-2369-12-20] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 05/13/2011] [Indexed: 12/15/2022] Open
Abstract
Background Aluminium-containing phosphate binders have long been used for treatment of hyperphosphatemia in dialysis patients. Their safety became controversial in the early 1980's after reports of aluminium related neurological and bone disease began to appear. Available historical evidence however, suggests that neurological toxicity may have primarily been caused by excessive exposure to aluminium in dialysis fluid, rather than aluminium-containing oral phosphate binders. Limited evidence suggests that aluminium bone disease may also be on the decline in the era of aluminium removal from dialysis fluid, even with continued use of aluminium binders. Discussion The K/DOQI and KDIGO guidelines both suggest avoiding aluminium-containing binders. These guidelines will tend to promote the use of the newer, more expensive binders (lanthanum, sevelamer), which have limited evidence for benefit and, like aluminium, limited long-term safety data. Treating hyperphosphatemia in dialysis patients continues to represent a major challenge, and there is a large body of evidence linking serum phosphate concentrations with mortality. Most nephrologists agree that phosphate binders have the potential to meaningfully reduce mortality in dialysis patients. Aluminium is one of the cheapest, most effective and well tolerated of the class, however there are no prospective or randomised trials examining the efficacy and safety of aluminium as a binder. Aluminium continues to be used as a binder in Australia as well as some other countries, despite concern about the potential for toxicity. There are some data from selected case series that aluminium bone disease may be declining in the era of reduced aluminium content in dialysis fluid, due to rigorous water testing. Summary This paper seeks to revisit the contemporary evidence for the safety record of aluminium-containing binders in dialysis patients. It puts their use into the context of the newer, more expensive binders and increasing concerns about the risks of calcium binders, which continue to be widely used. The paper seeks to answer whether the continued use of aluminium is justifiable in the absence of prospective data establishing its safety, and we call for prospective trials to be conducted comparing the available binders both in terms of efficacy and safety.
Collapse
Affiliation(s)
- David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia.
| | | | | | | | | | | | | |
Collapse
|
38
|
Barreto FC, Araújo SMHA. Intoxicação alumínica na DRC. J Bras Nefrol 2011. [DOI: 10.1590/s0101-28002011000200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
Sandhu G, Djebali D, Bansal A, Chan G, Smith SD. Serum Concentrations of Aluminum in Hemodialysis Patients. Am J Kidney Dis 2011; 57:523-5. [DOI: 10.1053/j.ajkd.2010.10.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/30/2010] [Indexed: 11/11/2022]
|
40
|
|
41
|
Kan WC, Chien CC, Wu CC, Su SB, Hwang JC, Wang HY. Comparison of low-dose deferoxamine versus standard-dose deferoxamine for treatment of aluminium overload among haemodialysis patients. Nephrol Dial Transplant 2009; 25:1604-8. [DOI: 10.1093/ndt/gfp649] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
42
|
Golli-Bennour EE, Kouidhi B, Dey M, Younes R, Bouaziz C, Zaied C, Bacha H, Achour A. Cytotoxic effects exerted by polyarylsulfone dialyser membranes depend on different sterilization processes. Int Urol Nephrol 2009; 43:483-90. [DOI: 10.1007/s11255-009-9653-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
|
43
|
|
44
|
Kaufman AM, Abraham JA, Kattapuram SV, Hornicek FJ. Orthopaedic . radiology . pathology conference: Chronic multifocal chest and leg pain in a 34-year-old woman. Clin Orthop Relat Res 2009; 467:1112-7. [PMID: 18810567 PMCID: PMC2650065 DOI: 10.1007/s11999-008-0516-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 08/27/2008] [Indexed: 01/31/2023]
Affiliation(s)
- Adam M. Kaufman
- Harvard Medical School, Boston, MA USA ,Department of Orthopaedics, Duke University Hospital, Duke Orthopaedic Surgery, 200 Trent Dr., 5313 Duke Clinic Bldg., Box 3000, Durham, NC 27710 USA
| | - John A. Abraham
- Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA USA
| | | | | |
Collapse
|
45
|
Bohrer D, Bertagnolli DC, de Oliveira SMR, do Nascimento PC, de Carvalho LM, Garcia SC, Arantes LC, Barros EJG. Role of medication in the level of aluminium in the blood of chronic haemodialysis patients. Nephrol Dial Transplant 2008; 24:1277-81. [DOI: 10.1093/ndt/gfn631] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
The influence of the hemodialysis treatment time under oxidative stress biomarkers in chronic renal failure patients. Biomed Pharmacother 2008; 62:378-82. [DOI: 10.1016/j.biopha.2007.10.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 08/16/2007] [Accepted: 10/24/2007] [Indexed: 11/17/2022] Open
|
47
|
Valentini J, Schmitt GC, Grotto D, Santa Maria LD, Boeira SP, Piva SJ, Brucker N, Bohrer D, Pomblum VJ, Emanuelli T, Garcia SC. Human erythrocyte δ-aminolevulinate dehydratase activity and oxidative stress in hemodialysis patients. Clin Biochem 2007; 40:591-4. [PMID: 17462617 DOI: 10.1016/j.clinbiochem.2007.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 01/30/2007] [Accepted: 02/13/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Oxidative stress is a complicating factor in chronic renal failure, especially in hemodialysis (HD) patients. Also, aluminum intoxication may occur during hemodialysis treatment. Aluminum has been shown to inhibit the sulfhydryl-containing enzyme delta-aminolevulinate dehydratase (ALA-D). Thus, the involvement of -SH oxidation in ALA-D inhibition and its relationship with serum Al levels and lipid peroxidation in HD patients were evaluated. METHODS Blood ALA-D activity, plasma thiobarbituric acid reactive substances (TBARS), and serum aluminum levels were measured in HD patients (n=37) and healthy controls (n=20). RESULTS TBARS and Al levels were higher in HD patients than in controls (p<0.01), while ALA-D activity was lower (p<0.05). The sulfhydryl-reducing agent dithiothreitol (DTT) reactivated ALA-D of HD patients, but activity was still lower than that of controls. ALA-D activity was negatively correlated with TBARS (r=-0.63, p<0.01) and aluminum levels (r=-0.31, p<0.05). CONCLUSIONS Reduced ALA-D activity in HD patients was found to be related to the oxidation of -SH groups essential for enzyme activity. Our results suggest that increased oxidative stress may have contributed to enzyme inhibition in HD patients.
Collapse
Affiliation(s)
- Juliana Valentini
- Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
|