Aluminium exposure in haemodialysis and peritoneal dialysis patients: Experience of a single centre

Manickam RANGASAMI, Tholappan RAJENDRAN, Joseph CHAKKO, Jayashree RANGASAMI, Mahummad Abdul Mabood KHALIL, Sartaj ALAM, Jackson TAN.

Department of Renal Medicine, Suri Seri Begawan Hospital, Brunei Darussalam

ABSTRACT

Introduction: Aluminium exposure and toxicity are uncommon in humans. However it may occur in patients on long term haemodialysis (HD) due to water exposure during treatment. We retrospectively assessed the extent of aluminium exposure in our HD and peritoneal dialysis (PD) patients from 2002 to 2008. Materials and Methods: The study population included 43 HD patients and 77 PD patients whose blood samples were collected at four monthly intervals. In addition, HD patients were also interviewed on lifestyle factors (aluminium cookware, diet, aluminium-containing medications and tap water consumption) that may impact on serum aluminium levels. Reverse osmosis (RO) water aluminium levels were also collected during this timeframe. Results: More patients on HD had readings above the accepted range (>0.01mg/L) than peritoneal dialysis (36.9% vs. 23.8%). The mean aluminium values for HD and PD patients were 63.35 ± 34.69µg/L and 38.34 ± 17.02µg/L respectively (p<0.05). Use of aluminium cookware was identified as a risk factor for high aluminium readings in HD patients. The trend of serum aluminium correlated with that of RO water aluminium during the studied period. There was no evidence of clinical toxicity in our patients during follow up. Conclusion: The study showed that HD patients are at a higher risk of aluminium toxicity compared to PD patients. Treated RO water aluminium should be analysed on a regular basis to prevent aluminium toxicity in HD patients. Lifestyle factors may have an impact on aluminium levels in patients with renal disease.

Keywords: Complications, dialysis, metal toxicity, risk factors

Correspondence author: Jackson TAN, Department of Renal Medicine, Rimba Dialysis Centre, Gadong, Bandar Seri Begawan, Brunei Darussalam. Tel: +673 2450483, Fax: +673 2450483

E mail: drjacksontan@yahoo.co.uk

Brunei Int Med J. 2012; 8 (4): 173-178