In end-stage renal failure, does infection lead to elevated plasma aluminium and neurotoxicity? Implications for monitoring.
The well-described long-term effects of sustained exposure to aluminium in patients with end-stage renal failure (ESRF) are a result of uptake and storage of aluminium, leading to cellular toxicity. A case is presented suggesting that this aluminium may be mobilizable, and indicating the consequence of such release. A patient on haemodialysis (HD) presented acutely with infection, a raised CRP, decreased conscious level, impaired cognition and agitation. Subsequent neurological recovery over six to seven days appeared to follow the return of markedly elevated plasma aluminium concentrations to basal (i.e. from 25.2 micromol/L to 2.5 micromol/L; reference range < 0.5 micromol/L), coupled with a resolution of the infection. The patient was on long-term aludrox therapy 3 g/day, and showed relative resistance to the exogenous hormone erythropoietin, resulting in a refractory anaemia and suggesting aluminium toxicity. A series of HD patients (n = 5) presenting with bacteraemia, not on aludrox, showed no appreciable rise in the plasma aluminium mean of 1.3 micromol/L (SD 0.9; range 0.6-2.0 micromol/L). We suggest that infection can result in release of tissue aluminium, leading to acutely elevated plasma aluminium concentrations and signs of neurotoxicity. The amount of tissue storage and resultant aluminium release seemed to be related to the use of aluminium hydroxide as a phosphate binder.
Fenwick
Sean
S
Department of Renal Medicine, The Royal Liverpool and Broadgreen University Hospitals, Liverpool L7 8XP, Merseyside, UK.
Roberts
Edward A
EA
Mahesh
Balakrishna S
BS
Roberts
Norman B
NB
D000368:Aged; D000535:Aluminum / Q000097:blood* / Q000633:toxicity*; D000536:Aluminum Hydroxide / Q000009:adverse effects / Q000378:metabolism; D004338:Drug Combinations; D006801:Humans; D007239:Infections / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008276:Magnesium Hydroxide / Q000009:adverse effects / Q000378:metabolism; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced*; D006435:Renal Dialysis / Q000009:adverse effects
D004338:Drug Combinations; C013591:aluminum hydroxide, magnesium hydroxide, drug combination; D000536:Aluminum Hydroxide; D000535:Aluminum; D008276:Magnesium Hydroxide