Risk Factors in Aluminum Toxicity in Children with Chronic Renal Failure

Santos, Fernando; Massie, Martha D.; Chan, James C.M.

doi:10.1159/000183665

Cited by 21 publications

(4 citation statements)

References 62 publications

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“…However, we have been faced with serious diseases attri butable to Al due to the introduction of artificial kidney, i.e., vitamin D resistant osteomalacia, dialysis dementia and microcytic anemia [13,16,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…In HD therapy, the morbid states of vitamin D resis tant osteomalacia, dialysis encephalopathy and micro cytic anemia which are all caused by Al have been clari fied [13,16,21,22]. The accumulation of Al in HD patients is supposed to be caused by unexpected absorption through dialysis [4,5,8,12,20], gastrointestinal absorp tion of Al dosed as phosphate binder [3,6,9,10,15,23], high protein-binding capacity of Al in the blood [7] and its high affinity in the tissue [2,10,11,14,17].…”

Section: Introductionmentioning

confidence: 99%

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Aluminum Accumulation in the Skin in End-Stage Renal Failure

Ichimaru¹,

Horie

1987

Nephron

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Accumulation of aluminum (Al) of the skin of end-stage renal failure (ESRF) patients was analysed by means of an energy dispersive X-ray spectrometer (Kevex 7000 series). The Al detecting ratio was higher in the hemodialysis (HD) groups than in the non-dialysis ESRF group (p < 0.025) and the normal volunteer group (p < 0.01). There were no significant differences between the duration of HD (group I and group II), and between the non-dialysis ESRF and the normal volunteer groups. High Al accumulation detected in the skin of the HD groups may be attributed to the dosing of aluminum hydroxide gel (Al-gel), judging from the fact that all cases in the HD groups had been dosed with Al-gel (0.75–4.5 g/day). High Al detections were observed in 2 cases each of the HD and nondialysis ESRF groups responding HBs-antigen positive.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Aluminum Accumulation in the Skin in End-Stage Renal Failure

Ichimaru¹,

Horie

1987

Nephron

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“…There is evidence that uraemia per se increases gastrointestinal absorption of aluminium in man and the rat [56,571. Uraemic children also have an increased incidence of aluminium loading and toxicity [58], perhaps because they need large doses of phosphatebinders relative to body weight; and the effects of uraemia and citrate on aluminium absorption appear to be synergistic [21]. Fig.…”

Section: Factors Affecting Aluminium Absorptionmentioning

confidence: 99%

Aluminium: Gastrointestinal absorption and renal excretion

Lote

Saunders

1991

Clinical Science

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INTRODUCTION: SOURCES AND BIOAVAILABILITY OF ALUMINIUM Aluminium is the most abundant metal and constitutes 8% of the earth's crust. It is a normal constituent of vegetable and animal tissues and is present in raw untreated water. In domestic tap-water supplies, aluminium may be present in high concentrations either from its presence in raw water or, more commonly, as a result of its use during the water-purification process. Aluminium in the metallic form is widely used for both industrial and domestic purposes, and a variety of aluminium salts are used in foods, fluids, cosmetics and medications. The toxicity of aluminium in patients with renal failure is now well documented, and dialysis encephalopathy, osteomalacia and anaemia are recognized hazards in such patients if aluminium is not excluded from dialysis fluids and medications. The safe levels of aluminium in food, water, medications and infusion fluids for subjects with normal renal function are unknown, but aluminium has been implicated as causative agent in a number of dementia diseases, including Alzheimer's disease.

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“…Although the use of reverse osmosis may permit low dose oral aluminium therapy to continue, it is impossible to be complacent about the continued long-term use of such drugs in the face of accumulating evidence of aluminium absorption from the gut (Fleming et al 1982;Alfrey 1986;Boyce et al 1987). Even if encephalopathy and fracturing osteomalacia (Maloney et al 1982) do not develop, the systemic accumulation of aluminium may have other long-term deleterious effects in the central nervous system (Per1 & Brody 1980) and those with impaired renal function and therefore impaired capacity to excrete aluminium are particularly at risk (Recker et al 1977;Santos et al 1986).…”

mentioning

confidence: 99%

Chemical Reactivity of Aluminium-based Pharmaceutical Compounds used as Phosphate-binders

Cargill

Dutkowskij

Prescott

et al. 1989

Journal of Pharmacy and Pharmacology

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Several aluminium-containing substances, including antacids used as phosphate-binders in treating renal failure, have been analysed in-vitro under different pH conditions for the release of Al3+ ions and for binding of phosphate. Control experiments on different forms of pure aluminium hydroxide validated the methods. At pH 2 it was the most amorphous forms which released Al3+ most rapidly. These aluminium ions, available for absorption by the patient, were released from all antacids tested, but no firm phosphate-binding was detected while the pH remained at 2. Phosphate was bound at pH 8, by adsorption onto the surface of aluminium hydroxide. No significant amounts of free Al3+ exist in solution at pH 8, since at that pH aluminium hydroxide is precipitated. The most amorphous forms of this solid were the most efficient phosphate-binders. Alumino-silicate salts require prior exposure to acid to produce free Al3+ before they can act as phosphate-binders, whereas amorphous aluminium hydroxide acts as an efficient phosphate-binder without prior exposure to acid. Chemical principles are employed to show why aluminium release and phosphate-binding are separate and independent processes. Methods are proposed for maximizing the activity of phosphate- binders in-vivo, while minimising aluminium release.

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Risk Factors in Aluminum Toxicity in Children with Chronic Renal Failure

Cited by 21 publications

References 62 publications

Aluminum Accumulation in the Skin in End-Stage Renal Failure

Aluminum Accumulation in the Skin in End-Stage Renal Failure

Aluminium: Gastrointestinal absorption and renal excretion

Chemical Reactivity of Aluminium-based Pharmaceutical Compounds used as Phosphate-binders

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