Acute Aluminium Intoxication in Patients on Continuous Ambulatory Peritoneal Dialysis

Gumming, AllanD.; Simpson, Graham; Bell, D.; Cowie, J. F.; Winney, R. J.

doi:10.1016/s0140-6736(82)90237-9

Cited by 44 publications

(6 citation statements)

References 6 publications

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“…No patient in this study developed a serum aluminium value in excess of 10 umol/1, and acute aluminium toxicity has only been described in patients with serum values in excess of 15 pmol/1 [8]. However, this outbreak of alumi nium toxicity occurred in a group of patients with chronic renal failure treated by continuous ambulatory perito neal dialysis.…”

Section: Discussionmentioning

confidence: 65%

“…The introduction of reverse-osmosis water treatment has led to a reduction in the incidence of aluminium toxicity in areas with a previously reported high incidence of dialysis dementia [6], However, signifi cant aluminium accumulation can also occur due to the ingestion of phosphate-binding agents which contain aluminium [7] and also from the contamination of perito neal dialysis fluid [8].…”

Section: Introductionmentioning

confidence: 99%

“…We therefore prospectively studied the serum aluminium in 19 patients with acute renal failure to ob serve whether toxic levels that have been associated with nausea, vomiting and abdominal pain, occur [8] and whether the hyperaluminaemia rapidly disappears with the onset of diuresis. The patients were treated by both haemofiltration using a low aluminium replacement so lution and haemodialysis using softened mains water; both groups received in addition parenteral fluids con taminated with aluminium.…”

Section: Introductionmentioning

confidence: 99%

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Accumulation of Aluminium in Patients with Acute Renal Failure

Davenport¹,

Roberts²

1989

Nephron

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Serum aluminium was monitored in 19 patients admitted with acute oligo-anuric renal failure. The maximum serum aluminium obtained during the course of treatment was greater (p < 0.05) in 4 patients treated by haemodialysis alone, mean ± sem 3.78 ± 0.71 μmol/l than in 4 patients treated only by haemofiltration, 0.60 ± 0.22 μmol/l. For those 11 patients treated by both haemodialysis and haemofiltration, the maximum serum aluminium was greater (p < 0.05) during treatment with haemodialysis, 2.7 ± 0.62 μmol/l than during treatment with haemofiltration, 1.36 ± 0.15 μmol/l. There was a significant positive correlation between the maximum serum aluminium during treatment with haemodialysis and the number of hours of haemodialysis given (r = 0.76, p < 0.001). There was no significant increase in serum aluminium due to the administration of human albumin solutions. The aluminium content of dialysate water represents a major source of aluminium in patients with acute renal failure; prevention by reverse-osmosis water purification is recommended.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accumulation of Aluminium in Patients with Acute Renal Failure

Davenport¹,

Roberts²

1989

Nephron

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“…Cumming et al [8] described four patients on peritoneal dialysis with anorexia, nausea, vomiting, abdominal pain and general malaise after the accidental use of a peritoneal dialysis fluid with a high aluminium content. Bakir et al [5] reported four patients with advanced chronic renal failure who were receiving oral citrate and aluminium hydroxide and who developed an acute condition with obtundation, myoclonic jerks, convulsions and coma followed by death within a month, in spite of desferrioxamine treatment [4].…”

Section: Discussionmentioning

confidence: 99%

High serum aluminium levels and acute reversible encephalopathy in a 4-year-old boy with acute renal failure

Moreno

Domı́nguez

et al. 1991

Eur J Pediatr

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We report a 4-year-old boy, in acute renal failure, who had acute encephalopathy with very high serum aluminium levels (135 micrograms/l [5 mumol/l]) after receiving vesical irrigations with alum. We believe that in situations of non-focal neurological deterioration with no apparent cause in patients with impaired renal function receiving aluminium-containing preparations, the possibility of acute aluminium poisoning should be considered.

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“…3 Most of the early occurrence of chronic Al toxicity was reported between 1965 and mid-1980s and primarily caused by excessive Al in dialyzate water in patients undergoing chronic hemodialysis (HD) therapy, 4 but it has also been reported after contaminated peritoneal dialysis (PD) fluid. 5 In the early days of dialysis, the preparation of dialyzate water was unsophisticated and subject to contamination from a number of sources, including the addition of Al as a flocculant to remove colloidal matter. Moreover, water purification often involved using stainless steel boilers, sometimes fitted with Al-based cathodic corrosion protection systems, leading to high Al levels in the dialyzate.…”

Section: Introductionmentioning

confidence: 99%

Assessing the utility of testing aluminum levels in dialysis patients

Sharma

Toussaint

Pickering

et al. 2014

Hemodialysis International

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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.

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Acute Aluminium Intoxication in Patients on Continuous Ambulatory Peritoneal Dialysis

Cited by 44 publications

References 6 publications

Accumulation of Aluminium in Patients with Acute Renal Failure

Accumulation of Aluminium in Patients with Acute Renal Failure

High serum aluminium levels and acute reversible encephalopathy in a 4-year-old boy with acute renal failure

Assessing the utility of testing aluminum levels in dialysis patients

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