Dose-response relationships in aluminium toxicity in humans

Area of Science:

• Toxicology
• Nephrology
• Neurology

Background:

• Aluminium exposure is linked to bone disease and neurotoxicity in patients with elevated blood aluminium levels.
• These conditions are particularly concerning in individuals with impaired kidney function.

Purpose of the Study:

• To determine the dose-toxicity relationships between aluminium exposure and associated bone disease and neurotoxicity.
• To critically analyze existing literature on human aluminium exposure and its health effects.

Main Methods:

• A systematic review of human cases of aluminium exposure was conducted from January 1966 to December 2020.
• Literature searches were performed across Embase, MEDLINE, PubMed, and TOXNET using specific keywords.
• Inclusion criteria required individual data on aluminium exposure and confirmed toxicity or overload.

Main Results:

• Data from 179 individuals across 37 papers were analyzed.
• Common exposure sources included dialysis fluid, oral aluminium hydroxide, and plasma exchange.
• Aluminium neurotoxicity was observed at significantly higher concentrations than bone disease or asymptomatic overload, especially in patients with chronic kidney disease.

Conclusions:

• Toxic aluminium exposure can lead to neurotoxicity and bone disease, particularly in patients with chronic kidney disease.
• Neurotoxicity occurred at lower concentrations with acute intravesical exposure compared to chronic exposure in dialysis patients.
• The findings suggest that aluminium neurotoxicity might occur at lower concentrations than previously thought, necessitating further investigation for the general population.