Role of medication in the level of aluminium in the blood of chronic haemodialysis patients

Bohrer, Denise; Bertagnolli, Denise de Castro; Oliveira, Sandra M. R. de; Nascimento, Paulo Cı́cero do; Carvalho, Leandro Machado de; Garcia, Solange Cristina; Arantes, Luiz Cláudio; Barros, Elvino José Guardão

doi:10.1093/ndt/gfn631

Cited by 24 publications

(22 citation statements)

References 13 publications

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“…The median aluminum concentration in 5% glucose solutions was 5 ng/g. 9 The aluminum concentration has been reported in numerous drugs, 34,35 but in only 3 medications similar to those used in the present study. The median aluminum concentration in electrolyte and flavored electrolyte solutions was 5 ng/g, comparable to the 6.2 mcg/L of the present study.…”

Section: Discussionsupporting

confidence: 52%

Toxic and Essential Trace Element Content of Commonly Administered Pediatric Oral Medications

Yokel¹,

Seger²,

Unrine³

2017

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVESThe aim of this study was to test the hypothesis that commonly administered pediatric oral medications are a significant source of toxic elements. The concentrations of 16 elements were determined in 14 frequently used pediatric oral medications. METHODSSamples were prepared for analysis by dilution or nitric acid microwave-assisted digestion and analyzed by inductively coupled plasma mass spectrometry. The intake of each element from administration for 1 week of the medication's maximum recommended daily dose to 6-month-olds was calculated and compared to an exposure guideline for that element. Exposure guidelines used for adverse effects were minimal risk levels, oral reference dose, permissible or permitted daily exposure, provisional tolerable weekly intake, and tolerable upper intake concentrations. Exposure guidelines utilized for desired effect were adequate intake and recommended dietary allowance.RESULTS Intake of the maximum recommended daily dose by 6-month-olds for 1 week would not deliver more than the exposure guideline of any of the elements, with the exceptions of chromium in several medications and zinc in the pediatric electrolyte solution, if it was consumed for 1 week.CONCLUSIONS Consumed alone, these frequently administered pediatric oral medications would not deliver amounts of toxic elements that exceed established exposure guidelines for adverse effects, nor would most significantly contribute to adequate intake of essential elements.

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Section: Discussionsupporting

confidence: 52%

Toxic and Essential Trace Element Content of Commonly Administered Pediatric Oral Medications

Yokel¹,

Seger²,

Unrine³

2017

The Journal of Pediatric Pharmacology and Therapeutics

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“…However, these newly developed medications have not become popular in many countries due to their high cost [20]. In addition, the source of aluminium may contribute to extra aluminium intake from other medications [21]. Therefore, aluminium overload is still a potential problem among the dialysis population.…”

Section: Discussionmentioning

confidence: 99%

Comparison of low-dose deferoxamine versus standard-dose deferoxamine for treatment of aluminium overload among haemodialysis patients

Chien

et al. 2009

Nephrology Dialysis Transplantation

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Background. Patients on maintenance haemodialysis are at high risk of aluminium overload. While deferoxamine (DFO) has potential adverse effects, lower DFO dosages may afford good efficacy with fewer side effects. We evaluated the therapeutic response of low-dose (2.5 mg/kg/ week) DFO among haemodialysis patients with aluminium overload. Methods. We recruited the participants via basal predialysis serum aluminium (Al) levels of ≥20 μg/L with clinical suspicion of aluminium toxicity or hyperparathyroidism indicating parathyroidectomy and positive DFO tests. Patients were randomly divided into standard-dose (5 mg/kg/ week) and low-dose (2.5 mg/kg/week) groups. We compared the differences of mineral biochemical and haematological parameters before and after DFO treatment. Successful treatment was defined as a serum aluminium increase of <50 μg/L by DFO test. Adverse events during DFO therapy between the groups were also compared. Results. In total, 42 haemodialysis patients completed treatment (standard-dose group, n = 21; low-dose group, n = 21). The demographic characteristics of the groups did not differ. Serum corrected calcium and ferritin decreased in both groups, while serum total alkaline phosphatase increased in both groups. Serum phosphorus increased in low-dose group (P = 0.029), while plasma intact parathyroid hormone increased in standard-dose group (P = 0.004). The successful treatment response rates did not differ between the two groups (standard-dose: 12/21, 57% vs low-dose: 13/21, 62%; P = 0.75). Conclusions. Low-dose DFO may offer similar therapeutic effects as standard-dose DFO therapy.

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“…Out of the 319 HD patients, 14 patients used oral Al(OH) 3 to control serum phosphate and three had serum Al higher than 250 μg/L. Ingested Al(OH) 3 is not the only source of Al that Bohrer et al (2009) found for patients with kidney disease, because injectable drugs (notably insulin, EPO, and Fe) were also significant Al sources. Jimenez et al (2011) concluded that Al-based phosphate binders could be used but in light of the risks for adynamic bone disease other measures (reduced dietary phosphate and increased dialysis duration) should be exhausted prior to considering use of Al-based phosphate binders.…”

Section: Environmental and Occupational Exposurementioning

confidence: 99%

Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts

Willhite¹,

Karyakina²,

Yokel³

et al. 2014

Critical Reviews in Toxicology

329

201

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Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability.Address for correspondence: Calvin C. Willhite, Risk Sciences International, 55 Metcalfe Street, Suite 700, Ottawa, ON, Canada. calvinwillhite@hotmail.com. Declaration of interestPartial funding for this work was provided by a contract to review the recent scientific literature on health effects of aluminum between the International Aluminium Institute (IAI, www.world-aluminium.org), the Aluminium Reach Consortium (ARC, www.aluminium-reach-consortium.eu), and Risk Sciences International (RSI, www.risksciences.com), a Canadian company established in 2006 in partnership with the University of Ottawa. Additional financial support was provided by the Natural Sciences and Engineering Research Council of Canada (NSERC) to D. Krewski, who holds the NSERC Chair in Risk Science at the University of Ottawa. C.C. Willhite, N.A. Karyakina, F. Momoli, and N. Yenugadhati were compensated by RSI for their contributions to the review. I. Arnold, T. Wisniewski and R. Yokel received no compensation from RSI for their contributions to this work. The authors, whose affiliations are shown on the title page, had sole responsibility for preparation of this paper, including determining the strategy for reviewing the scientific literature summarized in this article, synthesizing the findings, and drawing conclusions. Scientists associated with IAI/ARC were given the opportunity to review and offer technical comments on the paper, prior to submission to Critical Reviews in Toxicology. I. Arnold serves as a consultant to the International Aluminium Institute. None of the authors have appeared before regulatory agencies on behalf of the sponsors, or appeared as experts in legal proceedings concerning matters reviewed in this paper. The scientific opinions and conclusions expressed in the paper are exclusively those of the authors, and are independent of the sources of financial support. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptThe present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007). The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances.

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Role of medication in the level of aluminium in the blood of chronic haemodialysis patients

Abstract: Among the medications investigated, the injectables are the most significant source of aluminium for patients with renal insufficiency. This extra aluminium intake is reflected in higher aluminium levels in the patients' blood.

Cited by 24 publications

References 13 publications

Toxic and Essential Trace Element Content of Commonly Administered Pediatric Oral Medications

Toxic and Essential Trace Element Content of Commonly Administered Pediatric Oral Medications

Comparison of low-dose deferoxamine versus standard-dose deferoxamine for treatment of aluminium overload among haemodialysis patients

Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts

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