Aluminum Intoxication in Chronic Kidney Disease

Bone aluminum accumulation in the current era

In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.

A comprehensive review on environmental pollutants and osteoporosis: Insights into molecular pathways

A significant problem that has an impact on community wellbeing is environmental pollution. Environmental pollution due to air, water, or soil pollutants might pose a severe risk to global health, necessitating intense scientific effort. Osteoporosis is a common chronic condition with substantial clinical implications on mortality, morbidity, and quality of life. It is closely linked to bone fractures. Worldwide, osteoporosis affects around 200 million people, and every year, there are almost 9 million fractures. There is evidence that certain environmental factors may increase the risk of osteoporosis in addition to traditional risk factors. It is crucial to understand the molecular mechanisms at play because there is a connection between osteoporosis and exposure to environmental pollutants such as heavy metals, air pollutants, endocrine disruptors, metal ions and trace elements. Hence, in this scoping review, we explore potential explanations for the link between pollutants and bone deterioration through deep insights into molecular pathways. Understanding and recognizing these pollutants as modifiable risk factors for osteoporosis would possibly help to enhance environmental policy thereby aiding in the improvement of bone health and improving patient quality of life.

Clinical Outcomes of the Deleterious Effects of Aluminum on Neuro-Cognition, Inflammation, and Health: A Review

Introduction: In the scenario of metal toxicity, aluminum (Al) stands out as a ubiquitous type of metal that can be combined with other elements and form different compounds. Al is widely used daily as an adjuvant in vaccines, antacids, food additives (as components of AI-containing food additives), skin care products, cosmetics, and kitchenware, and can be an element or contaminant present in our daily life. Objective: To present a review of the main deleterious effects of Al on human health. Methods: The search was carried out from September 2022 to February 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using scientific articles from 2012 to 2023. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusions: A total of 115 files were search returned. Further, 95 articles were evaluated, and 44 were included in this review. Based on the results, measuring Al's relevance to health is essential in medicine. Several studies have demonstrated clinical outcomes and metabolic alterations with Al exposure. The tolerable weekly intake established by the European Food Safety Authority (EFSA) of 1 mg Al/kg body weight can be achieved through dietary exposure alone. Proven neurotoxicity in humans is the critical adverse effect of Al. A carcinogenic effect of Al has not been proven so far. Preventive medicine advocates that exposure to Al should be kept as low as possible. Chelating agents, such as calcium disodium ethylene diamine tetraacetic acid and deferoxamine, are options for acute poisoning, and monomethysilanetriol supplementation may be a long-term strategy with chelation potential. Further studies are needed to assess the impacts of Al on human health.

Overview of renal osteodystrophy in Brazil: a cross-sectional study

INTRODUCTION

The epidemiologic profile of renal osteodystrophy (ROD) is changing over time and cross-sectional studies provide essential information to improve care and health policies. The Brazilian Registry of Bone Biopsy (REBRABO) is a prospective, nationalmulticenter cohort that includes patients with chronic kidney disease (CKD) undergoing bone biopsy. REBRABO aims to provide clinical information on ROD. The main objective of this subanalysis was to describe the profile of ROD, including clinically relevant associations.

METHODS

From Aug/2015 to Dec/2021, 511 patients with CKD who performed bone biopsy were included in the REBRABO platform. Patients with no bone biopsy report (N = 40), GFR > 90 mL/min (N = 28), without asigned consent (N = 24), bone fragments inadequate for diagnosis (N = 23), bone biopsy indicated by a specialty other than nephrology (N = 6), and < 18 years old (N = 4) were excluded. Clinical-demographic data (e.g., age, sex, ethnicity, CKD etiology, dialysis vintage, comorbidities, symptoms, and complications related to ROD), laboratory (e.g., serum levels of total calcium, phosphate, parathormone, alkaline phosphatase, 25-hydroxyvitamin D, and hemoglobin), and ROD (e.g., histological diagnosis) were analyzed.

RESULTS

Data from 386 individuals were considered in this subanalysis of REBRABO. Mean age was 52 (42-60) years; 198 (51%) were male; 315 (82%) were on hemodialysis. Osteitis fibrosa (OF) [163 (42%)], adynamic bone disease (ABD) [96 (25%)] and mixed uremic osteodystrophy (MUO) [83 (21%)] were the most frequent diagnosis of ROD in our sample; 203 (54%) had the diagnosis of osteoporosis, 82 (56%) vascular calcification; 138 (36%) bone aluminum accumulation, and 137 (36%) iron intoxication; patients with high turnover were prone to present a higher frequency of symptoms.

CONCLUSIONS

A high proportion of patients were diagnosed with OF and ABD, as well as osteoporosis, vascular calcification and clinical symptoms.

Benefits and risks of essential trace elements in chronic kidney disease: a narrative review

Background and Objective

Chronic kidney disease (CKD) is an important public health concern. With the decline of renal function, CKD patients gradually progress to end-stage kidney disease and need to undergo dialysis or kidney transplantation to maintain life, bringing a heavy economic burden to the family and society. Therefore, it is necessary to effectively prevent and delay the progression of CKD. Essential trace elements play an indispensable role in CKD, and the objective of this study is to systematically review their benefits in the disease and summarize the risks of their excess.

Methods

The keywords "trace elements", "chronic kidney disease", "dialysis", "inflammation", and "fibrosis" and their combinations were used to search for relevant literature published in the PubMed database and Web of Science. We then summarized the role of trace element abnormalities in CKD patients in anemia, oxidative stress, inflammation, and chronic fibrosis, and the risk of their excess.

Key Content and Findings

Imbalance of essential trace elements is a common complication of CKD and a risk factor for CKD progression, cardiovascular events, and death. This article reviews the effects of essential trace elements (iron, zinc, selenium, copper, iodine, and manganese) on CKD. We analyze literature and discuss the advantages and disadvantages of various essential trace elements.

Conclusions

Research shows CKD patients have an imbalance of essential trace elements, and treatment based on these is an important direction for future exploration. A knowledge of the homeostasis of trace elements is important to improving the prognosis of CKD patients and delaying the progression of the disease.

Evaluation of Some Chemical Parameters of Hemodialysis Water: A Case Study in Iran

BACKGROUND

One of the most common diseases in the world is kidney failure, which can lead to the death of patients. Hemodialysis is a treatment for patients whose kidneys are failing. The water used to perform dialysis must be healthy, safe, and clean. This study aimed to investigate the concentration of heavy metals in hemodialysis water in one of the Hospitals in Iran and compare it with European Pharmacopeia (EPH) and Association for the Advancement of Medical Instrumentation (AAMI) standards.

METHODS

The present study is a descriptive-analytical study conducted on the inlet water of hemodialysis machines in hospital. The samples were collected for 3 months from June to September 2021, Which was examined in terms of free residual chlorine, electrical conductivity, pH, and calcium, magnesium, sodium, aluminum, zinc, copper, and lead concentration. Metals concentration in hemodialysis water was measured by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) technique.

RESULTS

The average value of parameters such as electrical conductivity, pH, residual free chlorine, sodium, calcium, magnesium, zinc, copper and lead in the hemodialysis water was less than the AAMI and EPH standards limits. There was a significant difference at the 95% confidence level with the standard limits, but the aluminum concentration was higher than the standard limits. Also, by examining the medical files of dialysis patients, the most observed problems were anemia and bone diseases, which are probably caused by exposure to high concentrations of aluminum in hemodialysis water.

CONCLUSION

In present study the aluminum concentration is higher than the standard limits. Considering that the higher aluminum concentration can cause diseases such as anemia, bone diseases, nervous deterioration, and death in hemodialysis patients, therefore, it is recommended to continuously evaluate and monitor the quality of hemodialysis water and the performance of its treatment system.

3-Aminopyridine Salicylidene: A Sensitive and Selective Chemosensor for the Detection of Cu(II), Al(III), and Fe(III) with Application to Real Samples

Interest in developing selective and sensitive metal sensors for environmental, biological, and industrial applications is mounting. The goal of this work was to develop a sensitive and selective sensor for certain metal ions in solution. The goal was achieved via (i) preparing the sensor ((E)-2-((pyridine-3-ylimino)methyl)phenol) (3APS) using microwave radiation in a short time and high yield and (ii) performing spectrophotometric titrations for 3APS with several metal ions. 3APS, a Schiff base, was prepared in 5 min and in a high yield (95%) using microwave-assisted synthesis. The compound was characterized by FTIR, XRD, NMR, and elemental analysis. Spectrophotometric titration of 3APS was performed with Al(III), Ba(II), Cd(II), Co(II), Cu(II), Fe(III), Mn(II), Ni(II), and Zn(II). 3APS showed good abilities to detect Al(III) and Fe(III) ions fluorescently and Cu(II) ion colorimetrically. The L/M stoichiometric ratio was 2:1 for Cu(II) and 1:1 for Al(III) and Fe(III). Low detection limits (μg/L) of 324, 20, and 45 were achieved for Cu(II), Al(III), and Fe(III), respectively. The detection of aluminum was also demonstrated in antiperspirant deodorants, test strips, and applications in secret writing. 3APS showed high fluorescent selectivity for Al(III) and Fe(III) and colorimetric selectivity towards Cu(II) with detection limits lower than corresponding safe drinking water guidelines.