Progressive dialysis encephalopathy. Role of aluminum toxicity

Abstract

In the article "Progressive dialysis encephalopathy" (Ann Neurol ~4 : 199-204, 1 9 7 8 ) , Drs Lederman and Henry considered the role of aluminum in the origin of dialysis encephalopathy 3s speculative. W-e were astonished that aluminum blood levels were not reported for their 9 patients.Like other authors 11, 31, we believe that aluminum toxicity probabl\, plays a role in the production of dialysis encephalopathv, at least in some cases.

Serum Aluminum Levels in Dialysis Dementia

“…During the 17 months since stopping his aluminum carbonate he has shown marked improvement in the signs and symp toms of dialysis dementia, and his serum aluminum level has progressively fallen from 670 to 300 p.g/1. Others have also reported improvement in a few patients with dialysis dementia after cessation of their aluminum-containing phosphate binders and worsening of symptoms when these were reinstituted [24,25]. Clearly, previous reports suggest that aluminum-contaminated dialysates may have been the major cause of dialysis dementia in several other centers.…”

Dialysis Encephalopathy: A Review

“…Reversible worsening of symptoms has been temporally associated with temporary readministration of aluminum-containing gels used to treat hyperphosphatemia in a few cases [49,501. Also, intercurrent conditions which may cause the release of aluminum from bone in chronically dialyzed patients (surgery, immobilization, hypophosphatemia, and corticosteroid therapy) have been suspected of precipitating DE [5, 6 , 15, 201.…”

“…Significant improvement of DE has been reported when aluminum-containing gels are discontinued [4-7, 9, 44, 491, and/or the dialysate is subjected to aluminum-clearing maneuvers [4][5][6][7]44,49] . Reversible worsening of symptoms has been temporally associated with temporary readministration of aluminum-containing gels used to treat hyperphosphatemia in a few cases [49,501.…”

Reversal of an aluminum-induced behavioral deficit by administration of deferoxamine.

“…The occurrence of dialysis encephalopathy has been shown to be related to ingestion of phosphate binding gels containing aluminum (Alfrey, Le Gendre, & Kaehny, 1976; Pogglitsch, Petek, Wawschinek, & Holzer, 1981; Wallace, 1981) and to aluminum contamination of the dialysate (Parkingson, Ward, & Kerr, 1981; Rozas & Port, 1979). In some cases the clinical symptoms of the encephalopathy have been successfully treated or prevented by the removal of aluminum-containing gels (Jack, Rabin, & McKinney, 1984; Masselot, Adhemar, Jaudon, Kleinknecht, & Galli, 1978; Wallace, 1981), by clearing the dialysate of aluminum (Rozas & Port, 1979) or by a combination of both treatments (Platts, 1980; Poisson, Mashaly, Lafforgue, 1979; Poisson, Mashaly, & Lebkiri, 1978). Readministration of the aluminum-containing gels to treat elevated phosphate levels has resulted in a reoccurrence of the encephalopathy (Masselot et al, 1978; Poisson et al, 1979).…”

“…In some cases the clinical symptoms of the encephalopathy have been successfully treated or prevented by the removal of aluminum-containing gels (Jack, Rabin, & McKinney, 1984; Masselot, Adhemar, Jaudon, Kleinknecht, & Galli, 1978; Wallace, 1981), by clearing the dialysate of aluminum (Rozas & Port, 1979) or by a combination of both treatments (Platts, 1980; Poisson, Mashaly, Lafforgue, 1979; Poisson, Mashaly, & Lebkiri, 1978). Readministration of the aluminum-containing gels to treat elevated phosphate levels has resulted in a reoccurrence of the encephalopathy (Masselot et al, 1978; Poisson et al, 1979).…”