The enigma of aluminum deposition in bone tissue from a patient with chronic kidney disease: a case report

Meira, Rodrigo Dias de; Carbonara, Cinthia Esbrile Moraes; Quadros, Kélcia Rosana da Silva; Santos, Carolina Urbini dos; Schincariol, Patrícia; Pessôa, Gustavo de Souza; Arruda, Marco Aurélio Zezzi; Jorgetti, Vanda; Oliveira, Rodrigo Bueno de

doi:10.1590/2175-8239-jbn-3882

Cited by 10 publications

(7 citation statements)

References 19 publications

(21 reference statements)

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“…The reasons underlying these associations are unknown and probably involve Al kinetics, diffusional clearance, and hormonal factors (estrogen and PTH) 34 . Water used for hemodialysis, intestinal absorption, medications, and parenteral and polyelectrolyte concentrate solutions remain possible sources of Al 35 - 38 .…”

Section: Discussionmentioning

confidence: 99%

Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO

et al. 2020

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“…7 Aluminium (Al) is the most ample metal on earth and human beings are often exposed to it. 8 Dietary aluminium is omnipresent but in such minor quantities that it is not a essential source of concern in individuals with normal elimination capacity. Commonly water supplies may contain a higher concentration because usually water is treated with the element before supply to general populations.…”

Section: Introductionmentioning

confidence: 99%

A Study on Aluminium Levels in Patients Undergoing Haemodialysis at a Tertiary Care Hospital

Kader¹,

Meera²,

Siddique³

et al. 2020

IJOPP

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Introduction: Aluminium studied as a potentially toxic metal and is commonly found in earth's crust. Aluminium toxicity may lead to: aluminium-induced bone disease, microcytic anaemia and neurological manifestation, such conditions more particular seen in patients with chronic renal failure and principally patients on haemodialysis. Objectives: The objective of our study was to measure a serum aluminium levels in patients undergoing haemodialysis at tertiary care hospital, Bengaluru. Materials and Methods: This was a prospective study, conducted on 50 patients who were on maintenance haemodialysis for more than 6 months. 5 ml of the blood was drawn from the antecubital vein from the patient before haemodialysis process. Collected blood samples were estimated for aluminium levels by GFAAS. The dialysis fluid and RO water were also tested similarly for presence of aluminium to correlate the possible contamination. Results: The results were; 6(12%) patients had serum aluminium levels within baseline i.e. <20μg/L, 18(36%) patients had serum aluminium levels between 21-60μg/L and 26 (52%) of the patients had serum aluminium levels above 60μg/L. The aluminium content varied in the dialysate fluid reaching greater than the standard safety limit. Conclusion: In our study we found that aluminium toxicity is a serious problem in patients undergoing haemodialysis. Patients performing haemodialysis for longer period showed higher level of aluminium. Patients age of 50 years and on haemodialysis for duration 3 years need to be monitored carefully for aluminium toxicity. The major source of elevated serum aluminium in our study participants appears to be dialysate fluid, use of aluminium utensils, OTC products and food habits of consult patients.

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“…This limitation in actual diagnostic practice in conjunction with prolonged and low-intensity exposures to Al sources might explain the elevated proportion of patients presenting the diagnosis of bone Al accumulation in our cohort and from others studies [ 8 – 10 , 12 – 14 ]. Since heterogeneous standards of water quality for hemodialysis treatment around the globe is not negligible it is plausible to expect these findings in other populations.…”

Section: Discussionmentioning

confidence: 72%

“…In Brazil, despite the adoption of international guidelines to prevent Al intoxication [ 11 ], we also still detect Al in bone [ 12 – 14 ]. Here, due to a unique characteristic, bone biopsies depend on the medical indication and the patient’s acceptance, since bone biopsy is analyzed in reference centers at no cost to the patient.…”

Section: Introductionmentioning

confidence: 99%

Effect of aluminum accumulation on bone and cardiovascular risk in the current era

et al. 2023

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Background The prevalence of aluminum (Al) intoxication has declined over the past 3 decades. However, different groups still report on the diagnosis of Al in bone. Prolonged and low-intensity exposures to Al may not be captured by serum Al measurements, preventing its proper diagnosis. We hypothesize that bone Al accumulation may be related to bone and cardiovascular events in the current Era. Aims To detect the diagnosis of bone Al accumulation; to explore bone and cardiovascular consequences of Al accumulation. Methods This is a sub-analysis of The Brazilian Registry of Bone Biopsy, a prospective, multicentre cohort, with a mean follow-up of 3.4 years, including patients with CKD undergoing bone biopsy; bone fracture and major cardiovascular events (MACE) were adjudicated; Al accumulation was identified by solochrome-azurine staining; history of previous Al accumulation was registered based on information provided by the nephrologist who performed the bone biopsy; bone histomorphometry parameters, clinical data, and general biochemistry were registered. Results 275 individuals were considered; 96 (35%) patients have diagnosed with bone Al accumulation and were younger [50 (41–56) vs. 55 (43–61) years; p = 0.026], had lower body mass index [23.5 (21.6–25.5) vs. 24.3 (22.1–27.8) kg/m2; p = 0.017], higher dialysis vintage [108 (48–183) vs. 71 (28–132) months; p = 0.002], presented pruritus [23 (24%) vs. 20 (11%); p = 0.005], tendon rupture [7 (7%) vs. 3 (2%); p = 0.03) and bone pain [2 (0–3) vs. 0 (0–3) units; p = 0.02]. Logistic regression reveals that prior bone Al accumulation [OR: 4.517 (CI: 1.176–17.353); p = 0.03] and dialysis vintage [OR: 1.003 (CI: 1.000–1.007); p = 0.046] as independent determinants of bone Al accumulation; minor perturbations in dynamic bone parameters and no differences in bone fractures rate were noted; MACE was more prevalent in patients with bone Al accumulation [21 (34%) vs. 23 (18%) events; p = 0.016]. Cox regression shows the actual/prior diagnosis of bone Al accumulation and diabetes mellitus as independent predictors for MACE: [HR = 3.129 (CI: 1.439–6.804; p = 0.004) and HR = 2.785 (CI: 1.120–6.928; p = 0.028]. Conclusions An elevated proportion of patients have bone Al accumulation, associated with a greater prevalence of bone pain, tendon rupture, and pruritus; bone Al accumulation was associated with minor perturbations in renal osteodystrophy; actual/prior diagnosis of bone Al accumulation and diabetes mellitus were independent predictors for MACE.

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The enigma of aluminum deposition in bone tissue from a patient with chronic kidney disease: a case report

Cited by 10 publications

References 19 publications

Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO

Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO

A Study on Aluminium Levels in Patients Undergoing Haemodialysis at a Tertiary Care Hospital

Effect of aluminum accumulation on bone and cardiovascular risk in the current era

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