Aluminium toxicity in chronic renal insufficiency

Area of Science:

• Environmental Toxicology
• Clinical Biochemistry
• Nephrology

Background:

• Aluminium is a common environmental element with known toxicity, particularly in patients with kidney dysfunction.
• Significant interest in aluminium toxicity has focused on the clinical setting of haemodialysis units.
• Aluminium exposure in dialysis patients stems from contaminated dialysis solutions and aluminium-containing phosphate binders.

Purpose of the Study:

• To elucidate the biochemistry and toxic mechanisms of aluminium.
• To review the clinical manifestations of aluminium toxicity in haemodialysis patients.
• To discuss current treatment and monitoring strategies for aluminium overload.

Main Methods:

• Review of clinical observations and existing literature on aluminium toxicity.
• Gel filtration chromatography used to separate aluminium-binding plasma species.
• Discussion of analytical techniques, including electrothermal atomic absorption spectrometry.

Main Results:

• Aluminium is a key factor in dialysis encephalopathy and dialysis osteodystrophy.
• Other associated conditions include microcytic anaemia and extraskeletal calcification.
• Gel filtration identified five plasma aluminium fractions, including low molecular weight and protein-bound species.

Conclusions:

• Aluminium overload is treatable with desferrioxamine chelation and haemodialysis.
• Strict control of dialysate aluminium (10-15 µg/L) is essential.
• Accurate analytical methods are critical for effective aluminium monitoring, despite existing challenges.