Serum Aluminum Research Articles

Alteration of Some Heavy Metals and Kidney Function Tests in Serum of Crude Oil Station Workers

Some trace metals have no biological role, are toxic when in a certain form andconcentration. The aim of the present study is to study the effects of exposure to thevapors of crude oil (vehicle fuel) on some trace elements value and kidney function testsin serum of crude oil station workers. The study includes (30) men crude oil stationworkers (group 1), and (30) men non crude oil station workers (group 2). The meanvalue of serum aluminum (Al), barium (Ba), zinc (Zn), manganese (Mn), iron (Fe), andvanadium (V) were significantly higher in (group 1) compared with (group 2) (p<0.05),while the mean value of serum silver (Ag) in group 2 was significantly higher than thatof group 1, while {mercury (Hg), and lead (Pb)} in group 1 no significantly higher thanthat of group2, the serum creatinine and uric acid in group 1 was significantly higherthan that of group 2, and serum urea in group 1 was non significantly higher than that ofgroup 2. Based on the findings of the present study, it can be concluded trace elementsin serum of crude oil station workers are abnormal and affect dramatically of kidneyfunctions.

Aluminum Toxicity: Evaluation of 16-Year Trend Among 14 919 Patients and 45 480 Results.

- Annual monitoring with serum aluminum measurements is recommended for dialysis patients who are susceptible to toxic accumulation from contaminated dialysis fluid or from ingestion of aluminum-containing medications. - To evaluate long-term trends in serum aluminum concentrations and frequency of chronic toxicity. - A retrospective observational study was conducted by analyzing serum aluminum results obtained from the Veterans Affairs corporate data warehouse. Serum aluminum concentrations of 60 μg/L or greater were considered false positives and not indicative of chronic toxicity if another specimen retested within 45 days had a concentration below 20 μg/L. - A total of 45 480 serum aluminum results involving 14 919 patients and 119 Veteran Affairs facilities during a 16-year period ending in October 2016 were evaluated. The percentage of elevated (≥20 μg/L) serum aluminum results declined from 31.5% in 2000 to 2.0% in 2015. Average testing intervals changed from every 159 days in 2000 to every 238 days in 2015. Of 529 patients with serum aluminum concentrations of 60 μg/L or greater, 216 (40.8%) were retested within 45 days (average = 21 days); of these, 83 (38.4%) had concentrations below 20 μg/L after repeated measurements. Retesting rates increased with higher initial serum aluminum concentrations. - Aluminum toxicity, as assessed by serum levels, has substantially declined over time and is now rare. Many serum aluminum concentrations in the toxic range were not confirmed after retesting. Patients with toxic serum aluminum concentrations should be retested with another specimen before undergoing treatment or investigating sources of exposure to verify abnormal results.

Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis.

The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6–2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52–3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63–3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28–2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.

Effects of occupational exposure to aluminium on some oxidative stress and DNA damage parameters.

The aim of this work was to investigate the relationships between aluminium levels, oxidative status and DNA damage in workers occupationally exposed to aluminium. This study was conducted in a secondary aluminium smelter. It included 96 male workers occupationally exposed to aluminium fume and dust compared to 96 male nonexposed individuals. Full history and clinical examination were done for all participants. Laboratory investigations in the form of serum aluminium, total antioxidant capacity (TAC), urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and comet assay test were performed. Serum aluminium level ranged from 4 to 30 µg/L of median: 10 µg/L; urinary 8-OHdG ranged from 2.7 to 17.2 ng/mg creatinine of median: 7.6 ng/mg creatinine; comet tail length (CTL) ranged from 19.7 to 50.5 µm of median: 45 µm, were statistically significantly increased in the exposed group compared to nonexposed group. In exposed workers, a statistically significant positive correlations were found between serum aluminium level and urinary 8-OHdG ( r = 0.75, p < 0.001); aluminium level and CTL ( r = 0.71, p < 0.001); and urinary 8-OHdG and CTL ( r = 0.71, p < 0.001). There was a statistically significant negative correlation between serum aluminium and TAC ( r = -0.76, p < 0.001). Occupational exposure to aluminium in secondary aluminium smelters was related to the induction of oxidative stress and DNA damage. This may promote the development of adverse health hazards in the exposed workers.

ICP-MS determination of serum aluminum in monkeys subcutaneously administered an alhydrogel-formulated drug candidate.

To develop and validate an inductively coupled plasma-mass spectrometry method for quantitative bioanalysis of aluminum (Al) in monkey serum in support of a GLP TOX study with alhydrogel-formulated drug candidate. The method was linear over a dynamic range of 10-1000ng/ml using a 50-μl sample volume. The intra-/inter-run precision (%CV) of the quality control sample results were ≤7.9% (CV) and the accuracy (%bias) within ±11.0% across all quality control concentrations evaluated. Other validation parameters, including stability under various conditions, extraction recovery and matrix effect, all met the acceptance criteria. The validated method was successfully implemented for the quantitative analysis of Al in monkey serum to assess the systemic exposure to Al.

Intoxication aluminique en hémodialyse chronique. Un diagnostic rarement évoqué de nos jours. Illustration par un cas clinique et revue de la littérature

Aluminum intoxication in chronic hemodialysis patients has virtually vanished over the last decade. Therefore, the diagnosis is rarely advocated at present. Aluminum intoxication in dialysis patients associates to different degrees with dialysis encephalopathy, bone disorders and microcytic anemia. We report here the observation of a patient receiving intermittent hemodialysis therapy who presented with acute encephalopathy. It turned out to be caused by aluminum intoxication secondary to a defect in dialysis water treatment. Whatever the therapeutic approach, the prognosis of this dramatic complication in hemodialysis patients remains poor. In severe cases, only renal transplantation can be able to improve clinical outcome. Major sources of aluminum are tap water used for dialysis together with a defective water treatment system, and to a minor extent oral aluminum-containing phosphate binders and antacids. In the absence of a bone biopsy, the diagnosis can be made by measuring serum aluminum or better after a desferrioxamine test. Prevention of aluminum overload is of utmost importance. It is the responsibility of dialysis centers to provide aluminum-free water and dialysis fluid. In case of proven aluminum intoxication, the K/DOQI guidelines indicated how to best treat hemodialysis patients, based on long-term desferrioxamine infusions during the hemodialysis session. It is recommended to implement a stepwise increasing desferrioxamine dosage to prevent an acute decompensation with irreversible neurological lesions.

Association of low serum aluminum level with mortality in hemodialysis patients.

BackgroundThe National Kidney Foundation–Kidney Disease Outcomes Quality Initiative recommends that the serum aluminum level (SAL) should be below 20 µg/L for patients with maintenance hemodialysis (MHD). However, serum aluminum may have toxic effects on MHD patients even when it is in the apparently acceptable range (below 20 µg/L).MethodsThe Medical Ethics Committee approved this study. Initially, 954 MHD patients in dialysis centers were recruited. A total of 901 patients met the inclusion criteria and were followed-up for 1 year. Patients were stratified by SAL into four equal-sized groups: first quartile (<6 µg/L), second quartile (6–9 µg/L), third quartile (9–13 µg/L), and fourth quartile (>13 µg/L). Demographic, biochemical, and dialysis-related data were obtained for analyses. A linear regression model was applied to identify factors associated with SAL. Cox proportional hazard model was used to determine the significance of variables in prediction of mortality.ResultsOnly 9.3% of MHD patients had SALs of 20 µg/L or more. At the end of the follow-up, 54 patients (6%) died, and the main cause of death was cardiovascular disease. Kaplan–Meier survival analysis showed that patients in the fourth SAL quartile had higher mortality than those in the first SAL quartile (log rank test, χ2=13.47, P=0.004). Using the first quartile as reference, Cox multivariate analysis indicated that patients in the third quartile (hazard ratio =1.31, 95% confidence interval =1.12–1.53, P=0.038) and the fourth quartile (hazard ratio =3.19, 95% confidence interval =1.08–8.62, P=0.048) had increased risk of all-cause mortality.ConclusionThis study demonstrates that SAL, even when in an apparently acceptable range (below 20 µg/L), is associated with increased mortality in MHD patients. The findings suggest that avoiding exposure of aluminum as much as possible is warranted for MHD patients.

A Pilot Study Measuring Aluminum in Bone in Alzheimer's Disease and control Subjects Using in vivo Neutron Activation Analysis.

Aluminum, being the most abundant metal in the earth's crust, is widely distributed in the environment, and is routinely taken up by the human body through ingestion and inhalation. Aluminum is not considered an essential element and it can be toxic in high concentrations. Most of the body burden of aluminum is stored in the bones. Aluminum has been postulated to be involved in the causality of Alzheimer's disease. A system for non-invasive measurement of bone aluminum using the in vivo neutron activation analysis technique has been developed and previously reported in the literature by our group. The results are reported as ratio of Al to Ca in order to eliminate the variations in beam parameters and geometry as well as the physical variations among the subjects such as size of the hand and bone structure. This pilot study included 30 subjects, 15 diagnosed with Alzheimer's disease in mild and moderate stages and 15 control subjects, all of whom were 60 years of age or older. The mean value of aluminum for the control group was 2.7±8.2μg Al/g Ca (inverse-variance weighted mean 3.5±0.9μg Al/g Ca) and for the Alzheimer's disease subjects was 12.5±13.1μg Al/g Ca (inverse-variance weighted mean 7.6±0.6μg Al/g Ca). The difference between the mean of the Alzheimer's disease group and the mean of the control group was 9.8±15.9μg Al/g Ca, with a p-value of 0.02. An age-dependent linear increase in bone aluminum concentration was observed for all subjects. The difference in serum aluminum levels between the two groups did not reach significance.

ESTABLISHMENT OF AN INTERVENTION HEALTH EDUCATION PROGRAM FOR ENVIRONMENTAL, HEALTH PROMOTION OF ALUMINUM WORKERS

Even though aluminum is not considered to be a heavy metal like lead, it can be toxic in excessive amounts and even in small amounts if it is deposited in the brain. Many of the symptoms of aluminum toxicity mimic those of Alzheimer’s disease and osteoporosis. Colic, rickets, gastrointestinal problems, interference with the metabolism of calcium, extreme nervousness, anemia, headaches, decreased liver and kidney function, memory loss, speech problems, softening of the bones, and aching muscles can all be caused by aluminum toxicity. This study included 40 workers in an aluminum factory in 6th October District in Egypt with mean aluminum concentration in the different departments in the factory was within permissible exposure level PEL. Data were collected through a previously prepared questionnaire which consists of three parts. The first part was concerned with demographic data such as age and nationality. The second part was concerned with occupational data such as working hours, working years, smoking, and diseases. The third part concerned with knowledge, attitude and practice about aluminum hazards. The studied workers have reported the exposure to aluminum inside workplace during polishing and during smelting (85 % and 82.5 % respectively). However, majority of workers also reported an extra workplace exposure to aluminum with most of them in form of using alum. Utensils followed by use of food additives containing aluminum (72.5 % and 70 % respectively). By implementing the intervention study through the comprehensive health education program to workers in the factory, there was a statistically significant reduction in the mean serum aluminum before and after intervention (13.95 and 13.75 up/dl respectively) (P<0.01). Also, the intervention study has improved significantly the knowledge of workers toward the use of PPD by 45.5 % (P<0.01). At the same time, the knowledge of workers toward the exposure to the extra work sources of aluminum was significantly improved as regards aluminum Contained medications and aluminum Containing deodorants by 50 % and 62.5 % respectively (P<0.01). Finally Special safety precautions and educational programs are also needed to limit the aluminum exposure in this industrial group.

Shift from darbepoetin-α to continuous erythropoietin receptor activator decreases serum aluminium concentration in patients on hemodialysis.

The response of erythropoietic stimulating agents (ESA) in uremic patients may be associated with the changes of biochemical parameters, metal elements and inflammation status during the shift from one ESA to another. We compared changes in above mentioned factors after switching from darbepoetin-α (DPO) 20μg weekly for 10 weeks to continuous erythropoietin receptor activator (CERA) 100μg monthly for 10 weeks in uremic patients on hemodialysis. The haematocrit (Hct), metal elements and inflammation status are the primary outcome. Subjects included 54 patients without transfusion or bleeding or additional ESAs. Responders (IR, n=36) were defined as patients with an increase in Hct after the swtich. Although there was no significant difference in overall mean Hct after the switch (p=0.135), there are significantly greater mean number of red blood cells (RBC) (p=0.006), higher platelet numbers (p=0.001), larger RBCs (p=0.017) and higher creatinine (p=0.04) and total cholesterol (T-CHOL) (p=0.003) levels. Mean overall aluminium (Al) level decreased significantly (p=0.001). C-reactive protein (CRP) also decreased (p=0.016). The overall LDH increased (p=0.049) and potassium decreased significantly (p=0.036), which indicating active erythropoiesis. The calcium (Ca) level was significantly higher (p=0.034) and phosphate was significantly lower (p=0.028) after the shift. Although there was no significant increase in overall levels of parathyroid hormone (PTH) after the shift (p=0.061), but the pre-shift and post-shift PTH level was significantly higher in IRs than in non-IRs (p=0.003 and p=0.027, respectively). IRs had a significantly lower initial T-CHOL (p=0.03) and initial CRP (p=0.012) than non-responders, which may be related to lower inflammation. We found the shift from DPO to CERA results in lower Al levels, a reduced inflammatory response, and an increase in RBC number and PTH level in uremic patients on hemodialysis.

Association between serum aluminium level and methylation of amyloid precursor protein gene in workers engaged in aluminium electrolysis

To investigate the association between serum aluminium level and methylation of the promoter region of amyloid precursor protein (APP)gene in workers engaged in aluminium electrolysis. In 2012, 366 electrolysis workers in an aluminium factory were enrolled as exposure group (working years >10 and age >40 years)and divided into low-exposure group and high-exposure group based on the median serum aluminium level. Meanwhile, 102 workers in a cement plant not exposed to aluminium were enrolled as control group. Graphite furnace atomic absorption spectrometry was used to measure serum aluminium level, methylation specific PCR was used to measure the methylation rate of the promoter region of APP gene, and ELI-SA was used to measure the protein expression of APP in lymphocytes in peripheral blood. The exposure group had a significantly higher serum aluminium level than the control group (45.07 μg/L vs 30.51 μg/L, P< 0.01). The exposure group had a significantly lower methylation rate of the promoter region of APP gene than the control group (18.85% vs 25.49%, P=0.025), and the high-exposure group had a significantly lower methylation rate of the promoter region of APP gene than the low-exposure group (15.84% vs 21.85%, P<0.05). The exposure group had a significantly higher protein expression of APP in lymphocytes in peripheral blood than the control group (66.73 ng/ml vs 54.17 ng/ml, P<0.05); compared with the low-exposure group (65.39 ng/ml), the high-exposure group showed an increase in the protein expression of APP in lymphocytes in peripheral blood (67.22 ng/ml), but there was no significant difference between these two groups (P>0.05). The multivariate logistic regression analysis showed that with reference to the control group, low aluminium exposure (OR=1.86, 95% CI 1.67~3.52)and high aluminium exposure (OR=2.98, 95% CI 1.97~4.15)were risk factors for a reduced methylation rate of the promoter region of APP gene. Reduced methylation of the promoter region of APP gene may be associated with increased serum aluminium level, and downregulated methylation of the promoter region of APP gene may accelerate APP gene transcription.

Development of a Reproducible Model of Parenteral Nutrition-Associated Liver Disease in Rats.

For patients with intestinal failure, parenteral nutrition (PN) is a life-saving therapy. Unfortunately, hepatic dysfunction will occur in 40 to 60% of children on long-term PN. While the hepatic dysfunction is likely multifactorial, one important chemical component of the disease may be aluminum contamination of the PN. Previous studies have shown a reduction in liver injury by decreasing the aluminum concentration in PN in a pig model. We sought to develop a rat model of PN-associated liver disease (PNALD) with parenteral aluminum. Adult Sprague-Dawley rats had intravenous long-term catheters placed. The control group underwent daily injections of saline. The study rats had daily injections of either 2 or 3 mg/kg aluminum chloride (AlCl3). At the end of 4 weeks, the rats were euthanized and liver and blood samples were taken. The livers were analyzed and graded by a pathologist for histological evidence of liver degeneration and acute and chronic inflammation. The serum was analyzed for total bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). There was no difference in serum values of total bilirubin, alkaline phosphatase, ALT, or AST. There was no difference in acute inflammation among the groups (1 [control], 1.2 [2 mg/kg], 1.1 [3 mg/kg]). The rats treated with parenteral aluminum had significantly more Kupffer cells than the control group (0.1 [control], 3 [2 mg/kg], 2.2 [3 mg/kg], p < 0.0001 [control vs. 2 mg/kg] and 0.0032 [control vs. 3 mg/kg]). There was also more liver degeneration in the parenteral aluminum groups than the control group (1 [control], 2 [2 mg/kg], 2.5 [3 mg/kg], p = 0.0341 [control vs. 2 mg/kg] and 0.009 [control vs. 3 mg/kg]). However, there was no difference between 2 and 3 mg/kg AlCl3 for either variable. This study suggests that 4 weeks of parenteral aluminum can induce chronic inflammation and degeneration of the liver in rats. Therefore, we believe that daily injections of parenteral aluminum can produce a viable model of PNALD in rats. However, further studies are warranted, including measurement of serum aluminum levels in infants on PN.

Aluminum Levels in Brain, Serum, and Cerebrospinal Fluid are Higher in Alzheimer's Disease Cases than in Controls: A Series of Meta-Analyses.

Aluminum is the most studied environmental agent linked with Alzheimer's disease (AD). However, it remains unclear whether levels are significantly elevated in AD sufferers. To systematically assess levels of aluminum in brain, serum, and cerebrospinal fluid (CSF) of AD cases and controls. Electronic searches of Medline, Embase, PubMed, and Cochrane Library were conducted up to June 2015. Studies reporting brain, serum, or CSF aluminum levels in individuals with AD and non-demented controls were included. Meta-analyses were performed using random-effects models and the pooled standardized mean difference (SMD) reported with 95% confidence intervals (CI). Overall, 34 studies involving 1,208 participants and 613 AD cases met the criteria for inclusion. Aluminum was measured in brain tissue in 20 studies (n = 386), serum in 12 studies (n = 698), and CSF in 4 studies (n = 124). Compared to control subjects, AD sufferers had significantly higher levels of brain (SMD 0.88; 95% CI, 0.25-1.51), serum (SMD 0.28; 95% CI, 0.03-0.54), and CSF (SMD 0.48; 95% CI, 0.03-0.93) aluminum. Sensitivity analyses excluding studies without age-matched controls did not impact upon these results. The findings of the present meta-analyses demonstrate that aluminum levels are significantly elevated in brain, serum, and CSF of patients with AD. These findings suggest that elevated aluminum levels, particularly in serum, may serve as an early marker of AD and/or play a role in the development of the disease. These results substantially clarify the existing evidence examining the link between chronic aluminum exposure and the development of AD.

The Relationship Between Cognitive Impairment and Global DNA Methylation Decrease Among Aluminum Potroom Workers.

To investigate the relationship between cognitive impairment and global DNA methylation in aluminum (Al) potroom workers. A total of 366 Al-exposed workers were investigated, and their cognitive functions were assessed with the Mini-Mental State Examination (MMSE). Aluminum in serum was quantified using graphite furnace atomic absorption spectrometry. Global DNA methylation was analyzed in whole blood using an enzyme-linked immunosorbent assay-like reaction. Mini-Mental State Examination scores and global DNA methylation decreased with the increase of serum Al concentration. Forty-three mild cognitive impairment (MCI) people were diagnosed. Global DNA methylation of the MCI was lower than the non-MCI. Multiple logistic analysis showed that the Al-exposed workers had lower global DNA methylation and higher serum Al concentration and were at the higher risk of MCI. Long-term exposure to Al may cause MCI. Mild cognitive impairment was significantly associated with global DNA methylation in blood.

CoFe2O4 nano-particles functionalized with 8-hydroxyquinoline for dispersive solid-phase micro-extraction and direct fluorometric monitoring of aluminum in human serum and water samples

A simple dispersive solid-phase micro-extraction method based on CoFe2O4 nano-particles (NPs) functionalized with 8-hydroxyquinoline (8-HQ) with the aid of sodium dodecyl sulfate (SDS) was developed for separation of Al(III) ions from aqueous solutions. Al(III) ions are separated at pH 7 via complex formation with 8-HQ using the functionalized CoFe2O4 nano-particles sol solution as a dispersed solid-phase extractor. The separated analyte is directly quantified by a spectrofluorometric method at 370nm excitation and 506nm emission wavelengths. A comparison of the fluorescence of Al(III)–8-HQ complex in bulk solution and that of Al(III) ion interacted with 8-HQ/SDS/CoFe2O4 NPs revealed a nearly 5-fold improvement in intensity. The experimental factors influencing the separation and in situ monitoring of the analyte were optimized. Under these conditions, the calibration graph was linear in the range of 0.1–300ngmL−1 with a correlation coefficient of 0.9986. The limit of detection and limit of quantification were 0.03ngmL−1 and 0.10ngmL−1, respectively. The inter-day and intra-day relative standard deviations for six replicate determinations of 150ngmL−1 Al(III) ion were 2.8% and 1.7%, respectively. The method was successfully applied to direct determine Al(III) ion in various human serum and water samples.

English

The aim of the investigation is explore the features of the content and balance of toxic electrolytes (aluminum, cadmium and lead) in serum and red blood cells of newborns with disturbance kidney function due to asphyxia. Investigation included 200 full-term newborns with the signs of renal damage: 100 neonates suffered severe asphyxia, and 100 babies suffered moderate asphyxia. A comparison group comprised 20 infants without asphyxia at birth. Blood was collected on the 1–2 day of life, at the end of the early neonatal period (7–8 day of life), and at the end of the first month (25–30 day). The content of electrolytes in blood serum and erythrocytes was determined by atomic absorption spectrophotometry (AAS). For newborns with impaired renal function were typical high level of Al, Cd, Pb in blood serum during early neonatal period in case of moderate asphyxia or predominantly during whole 1 st month of life in case of severe form. Prolonged increase levels of toxic elements in erythrocytes more specific for neonates with disturbance kidney function due to severe asphyxia. Transmembrane ratio of all investigated toxic elements indicated on preferred movement ions inward of the cell.

Serum Aluminum Level and Its Relation with Parathyroid Hormone and Anemia in Children on Maintenance Hemodialysis

Aim: Renal excretion of aluminum is impaired in patients with chronic kidney disease, thereby increasing the risk of toxicity. Our aims were to determine the serum aluminum level in children on regular haemodialysis and to assess the effect of aluminum on PTH and blood parameters. Methodology: This is a case control study was done on 120 children, a group of 60 cases on regular hemodialysis, their ages ranged from 3 to 16 year. They were 27 males (45%) and 33 females (55%) they were selected from the hemodialysis unit and outpatient clinic of Al-Zahraa hospital, AL-Azhar University during the period from January 2014 to September 2014. The studied cases were divided into two groups according to the serum aluminum level; group A 50 μg/L. Another group of 60 apparently healthy children with matched age and sex with the patient group served as a control. All subjects underwent thorough history taking, clinical examination and the following investigations: complete blood count, blood urea, serum creatinine, Original Research Article Hegazy et al.; BJMMR, 7(6): 494-502, 2015; Article no.BJMMR.2015.355 495 total serum calcium, serum phosphorus, serum aluminum, ferritin, PTH and aluminum level of drinking water and water for dialysis. Results: In this study serum aluminum level was significantly higher in cases compared with controls, it was (60±20 μg/L) and (20±10 μg/L) respectively (P=.000). Also we found serum PTH was significantly higher while serum calcium was significantly lower in cases compared to controls particularly in children whose aluminum >50 μg/L. We found a significant positive correlation between serum aluminum levels with PTH (r=.50, P=.001). Also our study reported that the aluminum level in both tap water (for drinking) and water from the dialysis unit their levels were 300 μg/L and 1 μg/L respectively. Conclusion: Drinking water is the main source of high aluminum level in our study and its overload is still a serious health problem in hemodialysis children. So aluminum should be diminished from drinking water to reach the permissible limit; routine monitoring of aluminum level and new modalities of hemodialysis is recommended.

Determination of Aluminium by Electrothermal Atomization Atomic Absorption Spectrometry in Serum to Characterize Hemodialysis Toxicity

A simple and cost-effective method is described for the determination of aluminum by electrothermal atomic absorption spectrometry (ET-AAS) in serum of hemodialysis patients and healthy subjects. The only preparative step required is the dissolution of the serum sample in 0.2% magnesium nitrate matrix modifier and separate diluents 0.01 M EDTA and 0.1% Triton X-100. The calibration curve was linear from 20 to 100 µg/L with correlation coefficients of 0.9993 and 0.9998 for EDTA and Triton X-100, respectively. The sensitivity of the method for aluminum at the 309.3 nm line was 74 pg. The instrumental and method limits of detection were 2.2 µg/L and 4.4 µg/L, respectively. The aluminum concentrations of forty serum samples from hemodialysis patients and healthy subjects were determined and the mean values were 170.9 ± 6.8 µg/L and 47.3 ± 9.3 µg/L, respectively, whereas the permissible limit for aluminum in blood serum is 10 µg/L. The high level of Al in serum was related to oral phosphate binding agents and dialysis treatment.

Aluminum overload hampers symptom improvement following parathyroidectomy for secondary hyperparathyroidism.

Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism. From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups. A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 μg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041). A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.

Serum aluminum levels in dialysis patients after sclerotherapy of internal hemorrhoids with aluminum potassium sulfate and tannic acid.

Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for internal hemorrhoids. However, it is contraindicated for patients with chronic renal failure on dialysis, because the aluminum in ALTA can cause aluminum encephalopathy when it is not excreted effectively. We conducted this study to measure the serum aluminum concentrations and observe for symptoms relating to aluminum encephalopathy in dialysis patients after ALTA therapy. Ten dialysis patients underwent ALTA therapy for hemorrhoids. We measured their serum aluminum concentrations and observed them for possible symptoms of aluminum encephalopathy. The total injection volume of ALTA solution was 31 mL (24-37). The median serum aluminum concentration before ALTA therapy was 9 μg/L, which increased to 741, 377, and 103 μg/L, respectively, 1 h, 1 day, and 1 week after ALTA therapy. These levels decreased rapidly, to 33 μg/L by 1 month and 11 μg/L by 3 months after ALTA therapy. No patient suffered symptoms related to aluminum encephalopathy. Although the aluminum concentrations increased temporarily after ALTA therapy, dialysis patients with levels below 150 μg/L by 1 week and thereafter are considered to be at low risk of the development of aluminum encephalopathy.