Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
What are the hazards of aluminum intoxication in the dialysis population?
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
Aluminum in the general population could enter the body via
– ingestion i.e processed food, cookware, aluminum-containing medicine, or inhalation: especially in workers
– in dialysis patients, the main source is dialysate: even a trivial concentration gradient could cause significant toxicity
2- Difference in kidney clearance:
Patients on dialysis with reduced clearance are exposed to 300-600 L of water, even with normal concentrations of aluminum
2- The hazard of aluminum toxicity on dialysis patients:
osteomalacia
hypoparathyroidism
anemia
erythropoietin resistence
dialysis encephalopathy
increased mortality
3- consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, aluminum contamination of food during culinary preparation, food additive
4- increase cardiothoracic ratio and increase all cause mortality
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
Aluminium can enter the body in general population through:
GIT by ingestion of food stuff, drinking water and aluminium containing medicine
Skin: cosmotics
Inhalation: for workers in the industries that fabricate aluminium goods
While in dialysis patients, the main source is dialysate as esrd can be exposed to 300-600 L per week
What are the hazards of aluminum intoxication in the dialysis population?
Aluminium toxicity may be acute or chronic
Acute toxicity manifests as encephalopathy
Chronic toxicity may be manifested as osteomalacia, iron resistant anemia, adynamic bone disease
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
1- Consumption of aluminium containing medicine , as aluminium exists as and adulteration in many primary materials used to create medications, as calcium carbonate, vit B and folic acid.
2- Ingestion of aluminium containing food additives
3- Contamination from cookware
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
1-abonrmal aluminium level is associated with higher cardiothoracic ratio, which is associated with higher risk for all cause of mortality
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation. in the general population the aluminum exposure comes from allot of sources foods especially predeceased foods, aluminum containing medicines, osmotic products. ingestion and inhalation are the two routes of which aluminum enter the body.
the accumulation of aluminum in general population is not primarily. but in dialysis patients’ accumulation of aluminum may come from environmental dietary exposure , contaminated dialysate and lack of native kidney clearance without aluminum contaminated dialysate. 2.What are the hazards of aluminum intoxication in the dialysis population?
can encounter medical complications , osteomalacia , low level of PTH , anemia and can increase general mortality. 3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
There was no clear explanation for the abnormal blood aluminum level in the dialysis unit.
abnormal blood aluminum level where consumption of aluminum-contaminated medicines, aluminum-containing foods, or aluminum contamination of foods 4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
the study uses different parameters the cardiovascular risk was higher in abnormal blood aluminum levels in dialysis patients.
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
The general population is exposed to aluminum primarily through food, drinking water, and aluminum-containing medications, aluminum cookware, and certain personal care products (e.g. antiperspirants, sun creams, and toothpaste). In contrast, dialysis patients are exposed to high volumes of dialysate, which can lead to even small concentration gradients of aluminum between blood and dialysate having a substantial impact on aluminum toxicity. Additionally, dialysis patients may be prone to aluminum accumulation due to decreased kidney clearance and the use of aluminum-containing medications, such as phosphate-binding agents, drugs for secondary hyperparathyroidism, and erythropoiesis-stimulating drugs.
2. What are the hazards of aluminum intoxication in the dialysis population?
Aluminum intoxication in the dialysis population can lead to a variety of medical complications, such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs, dialysis encephalopathy, and increased mortality. It can also lead to potential ototoxicity, and even without an aluminum present in the dialysate, dialysis patients may be prone to excess aluminum due to a lack of native kidney clearance. 3. According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis include consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, or aluminum contamination of food during culinary preparation.
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
This study attempted to explore the association of pathogenic factors, such as demographic, clinical, and laboratory as well as the use of phosphate-binding drugs, drugs for secondary hyperparathyroidism, and erythropoiesis-stimulating drugs with blood aluminum levels.
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than in patients with normal blood aluminum levels (p = 0.003).
This suggests that elevated blood aluminum levels may be associated with an increased risk of cardiovascular disease in dialysis patients. Other studies have also shown that higher aluminum levels can be linked to increased risk of mortality in dialysis patients.
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels .Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis ,aluminum treatment created significant cardiotoxicity with oxidative damage in experimental animals. In an- other animal study, Novaes et al. proved that heart was vulnerable to aluminum toxicity. Long-term aluminum treatment produced genomic DNA oxidation, structural irregularities of myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes. At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling. In a study of 547 hemodialysis patients, Wang et al. also identified a significant association between blood aluminum levels and cardiomegaly (cardiothoracic ratio more than 0.5).
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
It might be due to the elimination of aluminum from water used for dialysis by reverse osmosis technique and use of nonaluminum-containing phosphate binders .
There is no exact explanation for the abnormal blood aluminum levels in the dialysis unit. However, the abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation. The medicines included calcium carbonate, vitamin B complex, folic acid, calcitriol, erythropoietin, iron sucrose, furosemide, heparin, etc., .Second, excessive intake of processed foods with aluminum-containing food additives is considered. Aluminum-containing food additives are permitted to be used as a leavening agent in steamed cake/bread and bakery goods, anticaking agent in powder mix, coloring agent in confections, and as a firming agent in jellyfish.
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In the general population, exposure to aluminum usually happens through the food- stuffs (processed foods), drinking water, and aluminum-containing medicines, aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste). The intake of aluminum from food and water is relatively little in comparison with aluminum-containing medicines. Inhalation and ingestion (via food and water) are the two principal routes through which aluminum enters into human body, but aluminum can also be absorbed through the skin . However, the penetration rate of aluminum following dermal product of antiperspirants is exceedingly low . For aluminium industry workers, there is another possibility for inhalation contact in the course of refining of primary metal and in secondary industries that fabricate aluminum goods (for example aircraft, automotive, and metal goods) and aluminum welding . Tobacco smoke may also add to the concentration of aluminum in the air.
Around 1.5 to 2% of inhaled and 0.01 to 5% of ingested aluminum is absorbed, and the absorbed aluminum is excreted largely in the urine. For the general population, alu- minum is not bioaccumulated to a great extent. Nevertheless, dialysis population should be considered as an exception. Accumulation of aluminum in dialysis population might arise from environmental or dietary exposure or contaminated dialysate. Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity . Moreover, absence of native kidney clearance in dialysis patients may also be prone to excess aluminum even not present in dialysate .
What are the hazards of aluminum intoxication in the dialysis population?
Therefore, aluminum accumulation is a important concern in dialysis population because aluminum poison- ing triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs , dialysis encephalopathy and increased mortality.
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation.
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels . Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis . Long-term aluminum treatment produced genomic DNA oxidation, structural irregularities of myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes. At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling.
What are the hazards of aluminum intoxication in the dialysis population?
aluminum accumulation is an important concern in dialysis population because aluminum poisoning triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs ,dialysis encephalopathy and increased mortality.
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In the general population, exposure to aluminum usually happens through the food- stuffs (processed foods), drinking water, and aluminum-containing medicines, aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste) .The intake of aluminum from food and water is relatively little in comparison with aluminum-containing medicines. Inhalation and ingestion (via food and water) are the two principal routes through which aluminum enters into human body, but aluminum can also be absorbed through the skin .However, the penetration rate of aluminum following dermal product of antiperspirants is exceedingly low .
For aluminum industry workers, there is another possibility for inhalation contact in the course of refining of primary metal and in secondary industries that fabricate aluminum goods (for example aircraft, automotive, and metal goods) and aluminum welding .Tobacco smoke may also add to the concentration of aluminum in the air.
For the general population, aluminum is not bioaccumulated to a great extent.
dialysis population should be considered as an exception. Accumulation of aluminum in dialysis population might arise from environmental or dietary exposure or contaminated dialysate. Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity .Moreover, absence of native kidney clearance in dialysis patients may also be prone to excess aluminum even not present in dialysate .Patients undertaking hemodialysis thrice per week are exposed to 300 to 600 L of water based on the dialysis prescription ,and patients undergoing peri- toneal dialysis also have large volume of dialysate exposure depending on their residual kidney function, solute clearance and peritoneal dialysis modalities. Therefore, aluminum accumulation is a important concern in dialysis population because aluminum poisoning triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs ,dialysis encephalopathy and increased mortality.
aluminum-containing binders,the abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation. aluminum exists as an adulteration in many raw materials used to produce medicines habitually used by dialysis patients. Unfortunately, the raw materials have warranty bulletins confirming their purity grade, but no limits for aluminum in these specifications. The medicines included calcium carbonate, vitamin B complex, folic acid, calcitriol, erythropoietin, iron sucrose, furosemide, heparin, etc., Second, excessive intake of processed foods with aluminum-containing food additives is considered. Aluminum-containing food additives are permitted to be used as a leavening agent in steamed cake/bread and bakery goods, anticaking agent in powder mix, coloring agent in confections, and as a firming agent in jellyfish.
1.Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation. general population:Food stuffs(processed food), Drinking water, Aluminum containing medicines, Aluminum -containing products e.g., cookware, cosmetic dialysis patients:The same as general population + Dialysis solution = Aluminum-based phosphate binders 2.What are the hazards of aluminum intoxication in the dialysis population? – Encephalopathy
-Anaemia (Microcytic) which results from ESA resistance
-Adynamic bone disease
3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis? The abnormal blood aluminum levels could possibly be explained by the consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, or aluminum contamination of food during culinary preparation. 4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels
Aluminum treatment created significant cardiotoxicity with oxidative damage in experimental animals.
Long-term aluminum treatment produced genomic DNA oxidation, and structural irregularities of the myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of the collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes
the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling .
Comparison between the general population and dialysis patients regarding the source of aluminum in the body and its accumulation. Aluminum source
Processed food.
Drinking water.
Drugs containing aluminum.
Aluminum cookware or cosmetic products.
Industry worker.
Tobacco smoking.
Contaminated dialysate in the dialysis populations.
In the general population
Aluminium has not accumulated to the great extent.
In the dialysis population
Aluminum accumulates from dialysate exposure (reduced after purification).
Absence of native renal clearance.
Aluminum Pi binder (not used now).
The hazards of aluminum intoxication in the dialysis population
ABD.
Osteomalacia.
Low PTH level.
Anemia.
Increase erythropoiesis need.
Dialysis encephalopathy.
Increased mortality.
According to Chuang et al, what are the explanations for abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
Consumption containing medicines.
Food containing aluminum.
Adulteration is used in the raw materials used in medicines.
Processed food.
The relation between aluminum levels and cardiovascular health in dialysis patients
The dialysis patient with the high aluminum level was found to have a higher cardiothoracic ratio which is associated with a higher risk of all-cause mortality.
Cardiotoxicity with oxidative damage.
Structural irregularity of myocardium, cardiac enlargment and remodeling.
a) Parynchymal loss. b) Stromal enlargement. c) Inflammatory cell infiltration. d) Collagen deposition. e) Decrease myocardium vascularity. f) Mitochondrial swelling. g) Sarcomere disorder.
h) Myofilament separation. i) Fragmentation of myocytes.
**Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In general population the source of aluminum from processed foods, foods cookware, drinking water, aluminum containing medicines and cosmetic products like antiperspirants, sunscreen and toothpaste. In industry workers exposed by inhalation to fabricate aluminum goods like aircraft, automotive, and aluminum welding, also tobacco smoke may add to concentration of aluminum while in dialysis patients in addition to environmental and dietary exposure, the contaminated dialysate and aluminum containing medicines like aluminum containing phosphate binders.
**What are the hazards of aluminum intoxication in the dialysis population?
Anemia, osteomalacia, dialysis encephalopathy, low PTH, resistance to erythropoietin and increase mortality
**According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
Due to consumption of aluminum containing medicines, aluminum containing foods or during culinary preparation 1. Aluminum exist in adulteration in many raw materials in production of medicine used by dialysis patients, the warranty bulletin not mention the aluminum in the purity grading. Examples of medicines calcium carbonate, Folic acid, erythropoietin, iron sucrose, furosemide, calcitriol, heparin and others
2. Excessive use of processed foods and food additives which used as leavening agent in steamed cake bread and bakery goods, anticaking agent in powder mix, coloring agent in confection and firming agent in jellyfish.
3. Aluminum contamination of foods during culinary preparation and aluminum cookware and foil especially in ckd patient.
**What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio is higher in patients with high blood aluminum due to genomic DNA oxidation, structural irrigularity of myocardium lead to parenchymal loss, stromal thickening, inflammatory cell infiltration, collagen deposition, collagen network breakdown, decrease myocardial vascularization, mitochondrial swelling, sarcolemal disorder, myofilament separation and fragmentation of myocyte then cardiac stromal show enlargement as a compensatory mechanism lead to constant pathologicalcardiac remodeling.
1.Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
general population: Food stuffs(processed food), Drinking water, Aluminum containing medicines, Aluminum -containing products e.g., cookware, cosmetic dialysis patients: The same as general population + Dialysis solution = Aluminum-based phosphate binders
2.What are the hazards of aluminum intoxication in the dialysis population? Osteomalacia, Low PTH, Anemia, Increased EPO needs, Dialysis encephalopathy, Increased mortality.
3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis? No clear explanation
May be aluminum-containing medicines or aluminum-containing food or during culinary preparation
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients? Cardiotoxicity, Cardiomyopathy, All-cause mortality
1-Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In the general population,Source of aluminum in the body the foodstuffs (processed food).drinking water, and aluminum-containing medicines,
aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste)
the absorbed aluminum is excreted largely in the urine so the general population, aluminum is not bioaccumulated
In dialysis patients from dialysate tap water and medication especially Aluminum contaning phosphate binders
aluminum is bioaccumulated to a great extent in dialysis population and lead aluminum toxicity .
2-What are the hazards of aluminum intoxication in the dialysis population?
These intoxication occur when level exceed 2mic/dl causing increased cardiac mortality.associated with thrombocytosis, hypertriglyceridemia,
encephalopathy anaemia which results from ESA resistance and adynamic bone disease.
3-According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
No definit explanation but mostly due to Consumption of aluminium containing medication,Consumption of aluminium containing foods,Cooking and use of Al based cookware.
4-What is the relation between aluminum levels and cardiovascular health in dialysis patients?
From the study the patients with aberrant blood aluminum levels have higher cardiothoracic ratios than patients with normal blood aluminum levels.It is also well established that aluminum treatment causes severe cardiotoxicity and that a larger cardiothoracic ratio is linked to a higher risk of all-cause mortality in patients receiving renal replacement therapy.
Prolonged aluminum exposure led to structural changes in a myocardium that cause chronic illness
1. The dialysis patients become more aluminium from untreated water through dialysis, high quantity medication ( e.g. Epotein, heparin), aluminum containing phosphate Binders. General population get aluminium from food conservative and from cooking .
2. Aluminum serum level above 2 Mikrogramm/deziliter is considered too much.
Aluminum intoxication can cause increase cardiorhoracic index above 0.5 and this associated with increased cardiac mortality.
Associated with thrombocytosis, hypertriglyceridemia, increased iron binding capacity.
Aluminum can cause anemia, encephalopathy, low turnover bone disease, decrease PTH level.
3. Cooking in aluminum based cookware
Medication containing aluminum.
Cosmetic products .
4. Association between increased cardiorhoracic index above 0.5 and abnormal level of aluminum what is the cause of increased mortality.
In animals experiences, aluminum treatment caused structural cardiac toxicity and cardiomyopathy.
1. Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation. 2. What are the hazards of aluminum intoxication in the dialysis population? 3. According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis? 4. What is the relation between aluminum levels and cardiovascular health in dialysis patients? In the general population, Source of aluminum in the body
1- the foodstuffs (processed foods), 2- drinking water, 3- and aluminum-containing medicines, 4- aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste) the absorbed aluminum is excreted largely in the urine For the general population, aluminum is not bioaccumulated to a great extent in dialysis patients
1- dialysate
2- medication
aluminum is bioaccumulated to a great extent in dialysis population and lead aluminum toxicity and associated with medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs , dialysis encephalopathy and increased mortality
1-Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
General population:
Processed foods
Drinking water, specialy water coming from natural sources eg wells
Aluminium -containing medication
Aluminium cookware
Aluminium cosmetic products
Dialysis population:
Dialysate
CKD can’t get rid of “normal” Al, so it accumulate
Al containing PO4 binder (almost obsolete now)
2-What are the hazards of aluminum intoxication in the dialysis population?
Encephalopathy
Anaemia (Microcytic) which results from ESA resistance
Adynamic bone disease
3-According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
Consumption of aluminium containing medication
Consumption of aluminium -containing foods
Cooking and use of Al based cookware
4-What is the relation between aluminum levels and cardiovascular health in dialysis patients?
Patients with aberrant blood aluminum levels have higher cardiothoracic ratios than patients with normal blood aluminum levels.
It is also well established that aluminum treatment causes severe cardiotoxicity and that a larger cardiothoracic ratio is linked to a higher risk of all-cause mortality in patients receiving renal replacement therapy.
Prolonged aluminum exposure led to structural changes in a myocardium that cause chronic illness
1.Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation. A.Source of aluminum for general population: inhalation, ingestion, & skin
B.Source of Aluminum for dialysis patients: Not so common these days
The same as general population plus
Dialysis solution = dialysate e.g., 300 to 600 L per week
Aluminum-based phosphate binders(historical)
C.Accumulation
For general population aluminum is not bioaccumulated to a great extend
For CKD, absence of native kidney clearance put patients at high risk of excess alumunium
2.What are the hazards of aluminum intoxication in the dialysis population?
Osteomalacia
Low PTH
Anemia
Increased EPO needs
Dialysis encephalopathy
Increased mortality
3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
No clear explanation
May be aluminum-containing medicines e.g adulteration in raw material, most CKD medicines
May be aluminum-containing food (leavening agent in bakery food, coloring agent in confections) or during culinary preparation e.g., cookware, and aluminum foil.
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
-Wide range of pathological changes in animals e.g., oxidative damage, parenchymal loss, reduced vascularity, mitochondrial swellings, & break down of collagen network. All these will results in:
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
General population:
Processed foods
Drinking water
Aluminium -containing medication
Aluminium cookware
Aluminium cosmetic products
Dialysis population:
Circulation of aluminium in dialysis patients might arise from environmental and/or dietary exposures as with the general population
These patients can also receive aluminium -containing phosphate binders which was commonly used in the past to help in the treatment of secondary hyperparathyroidism
What are the hazards of aluminum intoxication in the dialysis population?
Encephalopathy
Anaemia (Microcytic) which results in an increase erythropoietins use
Reduced levels of parathyroid hormone
Osteomalacia
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
Could be related to:
Consumption of aluminium containing medication
Consumption of aluminium -containing foods
Aluminium contamination of food during culinary preparation
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
From the study it was shown that the cardiothoracic ratio was higher in patients with abnormal blood aluminium level as compared to patients with normal aluminium blood levels. Capital is also known that higher cardiothoracic ratio is associated with higher risk for all-cause mortality in patients on renal replacement therapy, and is also known that aluminium treatment creates a significant cardiotoxicity
Chronic aluminium treatment produced structural abnormalities in a myocardium which results in chronic disease
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
For the general population, aluminum is not bioaccumulated to a great extent .Nevertheless, dialysis population should be considered as an exception. Accumulation of aluminum in dialysis population might arise from environmental or dietary exposure or contaminated dialysate.
Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity .Moreover, absence of native kidney clearance in dialysis patients may also be prone to excess aluminum even not present in dialysate .Patients undertaking hemodialysis thrice per week are exposed to 300 to 600 L of water based on the dialysis prescription and patients undergoing peritoneal dialysis also have large volume of dialysate exposure depending on their residual kidney function, solute clearance and peritoneal dialysis modalities.
What are the hazards of aluminum intoxication in the dialysis population?
Aluminum accumulation is a important concern in dialysis population because aluminum poisoning triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs, dialysis encephalopathy and increased mortality
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels
Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis
In a study of 547 hemodialysis patients, Wang et al. Also identified a significant association between blood aluminum levels and cardiomegaly (cardiothoracic ratio more than 0.5).
Aluminum treatment created significant cardiotoxicity with oxidative damage in experimental animals.
Novaes et al. proved that heart was vulnerable to aluminum toxicity.
Long-term aluminum treatment produced genomic DNA oxidation, structural irregularities of myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes. At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling
Compare between the general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In the general population, aluminum is commonly consumed via processed foods, drinking water, aluminum-containing pharmaceuticals, cookware, and cosmetics (for example, antiperspirants, sun creams, and toothpaste).
Food and water contain less aluminum than drugs. Aluminum enters the body by inhalation, ingestion, and skin absorption.
Dialysis patients are exceptions. Dialysis patients may accumulate aluminum via environmental, nutritional, or dialysate contamination. Chronic dialysis patients get huge amounts of dialysate; therefore, even small aluminum concentration gradients between blood and dialysate may cause significant toxicity.
What are the hazards of aluminum intoxication in the dialysis population?
osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs, dialysis encephalopathy, and increased mortality.
According to Chuang et al, what are the explanations for abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The abnormal blood aluminum levels could possibly be explained by the consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, or aluminum contamination of food during culinary preparation.
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels
Aluminum treatment created significant cardiotoxicity with oxidative damage in experimental animals.
Long-term aluminum treatment produced genomic DNA oxidation, and structural irregularities of the myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of the collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes
the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling
environmental or dietary exposure or contaminated dialysate.
Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity.
2- What are the hazards of aluminum intoxication in the dialysis population?
complications such as Osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs .
dialysis encephalopathy .
increased mortality.
3-According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
explanation
consumption of aluminum-contaminated medicines.
consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation .
4- What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher ( cardiomegaly) in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels .
Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis .
cardiotoxicity with oxidative damage .
structural irregularities of myocardium, causing
parenchymal loss
stromal enlargement,
inflammatory cell infiltrations.
collagen deposition, breakdown of collagen network, decreased myocardial vascularization.
A. source :
Aluminum in the general population could enter the body via
– ingestion i.e processed food, cookware, aluminum-containing medicine, or inhalation: especially in workers
– in dialysis patients, the main source is dialysate: even a trivial concentration gradient could cause significant toxicity
2- Difference in kidney clearance:
Patients on dialysis with reduced clearance are exposed to 300-600 L of water, even with normal concentrations of aluminum
2- The hazard of aluminum toxicity on dialysis patients:
osteomalacia
hypoparathyroidism
anemia
erythropoietin resistence
dialysis encephalopathy
increased mortality
3- consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, aluminum contamination of food during culinary preparation, food additive
4- increase cardiothoracic ratio and increase all cause mortality
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
Aluminium can enter the body in general population through:
GIT by ingestion of food stuff, drinking water and aluminium containing medicine
Skin: cosmotics
Inhalation: for workers in the industries that fabricate aluminium goods
While in dialysis patients, the main source is dialysate as esrd can be exposed to 300-600 L per week
What are the hazards of aluminum intoxication in the dialysis population?
Aluminium toxicity may be acute or chronic
Acute toxicity manifests as encephalopathy
Chronic toxicity may be manifested as osteomalacia, iron resistant anemia, adynamic bone disease
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
1- Consumption of aluminium containing medicine , as aluminium exists as and adulteration in many primary materials used to create medications, as calcium carbonate, vit B and folic acid.
2- Ingestion of aluminium containing food additives
3- Contamination from cookware
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
1-abonrmal aluminium level is associated with higher cardiothoracic ratio, which is associated with higher risk for all cause of mortality
2- aluminium treatment can cause cardiotoxicity,
the accumulation of aluminum in general population is not primarily. but in dialysis patients’ accumulation of aluminum may come from environmental dietary exposure , contaminated dialysate and lack of native kidney clearance without aluminum contaminated dialysate.
2.What are the hazards of aluminum intoxication in the dialysis population?
can encounter medical complications , osteomalacia , low level of PTH , anemia and can increase general mortality.
3.According to Chuang et al, what are the explanations of abnormal aluminum
levels in the studied patients despite water purification by reverse osmosis?
There was no clear explanation for the abnormal blood aluminum level in the dialysis unit.
abnormal blood aluminum level where consumption of aluminum-contaminated medicines, aluminum-containing foods, or aluminum contamination of foods
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
the study uses different parameters the cardiovascular risk was higher in abnormal blood aluminum levels in dialysis patients.
The general population is exposed to aluminum primarily through food, drinking water, and aluminum-containing medications, aluminum cookware, and certain personal care products (e.g. antiperspirants, sun creams, and toothpaste).
In contrast, dialysis patients are exposed to high volumes of dialysate, which can lead to even small concentration gradients of aluminum between blood and dialysate having a substantial impact on aluminum toxicity.
Additionally, dialysis patients may be prone to aluminum accumulation due to decreased kidney clearance and the use of aluminum-containing medications, such as phosphate-binding agents, drugs for secondary hyperparathyroidism, and erythropoiesis-stimulating drugs.
2. What are the hazards of aluminum intoxication in the dialysis population?
Aluminum intoxication in the dialysis population can lead to a variety of medical complications, such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs, dialysis encephalopathy, and increased mortality.
It can also lead to potential ototoxicity, and even without an aluminum present in the dialysate, dialysis patients may be prone to excess aluminum due to a lack of native kidney clearance.
3. According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis include consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, or aluminum contamination of food during culinary preparation.
4. What is the relation between aluminum levels and cardiovascular health in dialysis patients?
This study attempted to explore the association of pathogenic factors, such as demographic, clinical, and laboratory as well as the use of phosphate-binding drugs, drugs for secondary hyperparathyroidism, and erythropoiesis-stimulating drugs with blood aluminum levels.
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than in patients with normal blood aluminum levels (p = 0.003).
This suggests that elevated blood aluminum levels may be associated with an increased risk of cardiovascular disease in dialysis patients. Other studies have also shown that higher aluminum levels can be linked to increased risk of mortality in dialysis patients.
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels .Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis ,aluminum treatment created significant cardiotoxicity with oxidative damage in experimental animals. In an- other animal study, Novaes et al. proved that heart was vulnerable to aluminum toxicity. Long-term aluminum treatment produced genomic DNA oxidation, structural irregularities of myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes. At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling. In a study of 547 hemodialysis patients, Wang et al. also identified a significant association between blood aluminum levels and cardiomegaly (cardiothoracic ratio more than 0.5).
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
It might be due to the elimination of aluminum from water used for dialysis by reverse osmosis technique and use of nonaluminum-containing phosphate binders .
There is no exact explanation for the abnormal blood aluminum levels in the dialysis unit. However, the abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation. The medicines included calcium carbonate, vitamin B complex, folic acid, calcitriol, erythropoietin, iron sucrose, furosemide, heparin, etc., .Second, excessive intake of processed foods with aluminum-containing food additives is considered. Aluminum-containing food additives are permitted to be used as a leavening agent in steamed cake/bread and bakery goods, anticaking agent in powder mix, coloring agent in confections, and as a firming agent in jellyfish.
In the general population, exposure to aluminum usually happens through the food- stuffs (processed foods), drinking water, and aluminum-containing medicines, aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste). The intake of aluminum from food and water is relatively little in comparison with aluminum-containing medicines. Inhalation and ingestion (via food and water) are the two principal routes through which aluminum enters into human body, but aluminum can also be absorbed through the skin . However, the penetration rate of aluminum following dermal product of antiperspirants is exceedingly low . For aluminium industry workers, there is another possibility for inhalation contact in the course of refining of primary metal and in secondary industries that fabricate aluminum goods (for example aircraft, automotive, and metal goods) and aluminum welding . Tobacco smoke may also add to the concentration of aluminum in the air.
Around 1.5 to 2% of inhaled and 0.01 to 5% of ingested aluminum is absorbed, and the absorbed aluminum is excreted largely in the urine. For the general population, alu- minum is not bioaccumulated to a great extent. Nevertheless, dialysis population should be considered as an exception. Accumulation of aluminum in dialysis population might arise from environmental or dietary exposure or contaminated dialysate. Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity . Moreover, absence of native kidney clearance in dialysis patients may also be prone to excess aluminum even not present in dialysate .
Therefore, aluminum accumulation is a important concern in dialysis population because aluminum poison- ing triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs , dialysis encephalopathy and increased mortality.
The abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation.
The cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels . Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis . Long-term aluminum treatment produced genomic DNA oxidation, structural irregularities of myocardium, causing widespread parenchymal loss, stromal enlargement, inflammatory cell infiltrations, collagen deposition, breakdown of collagen network, decreased myocardial vascularization, mitochondrial swelling, sarcomere disorder, myofilament separation, and fragmentation of cardiomyocytes. At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling.
What are the hazards of aluminum intoxication in the dialysis population?
aluminum accumulation is an important concern in dialysis population because aluminum poisoning triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs ,dialysis encephalopathy and increased mortality.
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In the general population, exposure to aluminum usually happens through the food- stuffs (processed foods), drinking water, and aluminum-containing medicines, aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste) .The intake of aluminum from food and water is relatively little in comparison with aluminum-containing medicines. Inhalation and ingestion (via food and water) are the two principal routes through which aluminum enters into human body, but aluminum can also be absorbed through the skin .However, the penetration rate of aluminum following dermal product of antiperspirants is exceedingly low .
For aluminum industry workers, there is another possibility for inhalation contact in the course of refining of primary metal and in secondary industries that fabricate aluminum goods (for example aircraft, automotive, and metal goods) and aluminum welding .Tobacco smoke may also add to the concentration of aluminum in the air.
For the general population, aluminum is not bioaccumulated to a great extent.
dialysis population should be considered as an exception. Accumulation of aluminum in dialysis population might arise from environmental or dietary exposure or contaminated dialysate. Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity .Moreover, absence of native kidney clearance in dialysis patients may also be prone to excess aluminum even not present in dialysate .Patients undertaking hemodialysis thrice per week are exposed to 300 to 600 L of water based on the dialysis prescription ,and patients undergoing peri- toneal dialysis also have large volume of dialysate exposure depending on their residual kidney function, solute clearance and peritoneal dialysis modalities. Therefore, aluminum accumulation is a important concern in dialysis population because aluminum poisoning triggers many medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs ,dialysis encephalopathy and increased mortality.
aluminum-containing binders,the abnormal blood aluminum levels could possibly be explained by consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods or aluminum contamination of food during culinary preparation. aluminum exists as an adulteration in many raw materials used to produce medicines habitually used by dialysis patients. Unfortunately, the raw materials have warranty bulletins confirming their purity grade, but no limits for aluminum in these specifications. The medicines included calcium carbonate, vitamin B complex, folic acid, calcitriol, erythropoietin, iron sucrose, furosemide, heparin, etc., Second, excessive intake of processed foods with aluminum-containing food additives is considered. Aluminum-containing food additives are permitted to be used as a leavening agent in steamed cake/bread and bakery goods, anticaking agent in powder mix, coloring agent in confections, and as a firming agent in jellyfish.
1.Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
general population: Food stuffs(processed food), Drinking water, Aluminum containing medicines, Aluminum -containing products e.g., cookware, cosmetic
dialysis patients: The same as general population + Dialysis solution = Aluminum-based phosphate binders
2.What are the hazards of aluminum intoxication in the dialysis population?
– Encephalopathy
-Anaemia (Microcytic) which results from ESA resistance
-Adynamic bone disease
3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The abnormal blood aluminum levels could possibly be explained by the consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, or aluminum contamination of food during culinary preparation.
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
Comparison between the general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
Aluminum source
In the general population
In the dialysis population
The hazards of aluminum intoxication in the dialysis population
According to Chuang et al, what are the explanations for abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
The relation between aluminum levels and cardiovascular health in dialysis patients
a) Parynchymal loss.
b) Stromal enlargement.
c) Inflammatory cell infiltration.
d) Collagen deposition.
e) Decrease myocardium vascularity.
f) Mitochondrial swelling.
g) Sarcomere disorder.
h) Myofilament separation.
i) Fragmentation of myocytes.
**Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In general population the source of aluminum from processed foods, foods cookware, drinking water, aluminum containing medicines and cosmetic products like antiperspirants, sunscreen and toothpaste. In industry workers exposed by inhalation to fabricate aluminum goods like aircraft, automotive, and aluminum welding, also tobacco smoke may add to concentration of aluminum while in dialysis patients in addition to environmental and dietary exposure, the contaminated dialysate and aluminum containing medicines like aluminum containing phosphate binders.
**What are the hazards of aluminum intoxication in the dialysis population?
Anemia, osteomalacia, dialysis encephalopathy, low PTH, resistance to erythropoietin and increase mortality
**According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
Due to consumption of aluminum containing medicines, aluminum containing foods or during culinary preparation 1. Aluminum exist in adulteration in many raw materials in production of medicine used by dialysis patients, the warranty bulletin not mention the aluminum in the purity grading. Examples of medicines calcium carbonate, Folic acid, erythropoietin, iron sucrose, furosemide, calcitriol, heparin and others
2. Excessive use of processed foods and food additives which used as leavening agent in steamed cake bread and bakery goods, anticaking agent in powder mix, coloring agent in confection and firming agent in jellyfish.
3. Aluminum contamination of foods during culinary preparation and aluminum cookware and foil especially in ckd patient.
**What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio is higher in patients with high blood aluminum due to genomic DNA oxidation, structural irrigularity of myocardium lead to parenchymal loss, stromal thickening, inflammatory cell infiltration, collagen deposition, collagen network breakdown, decrease myocardial vascularization, mitochondrial swelling, sarcolemal disorder, myofilament separation and fragmentation of myocyte then cardiac stromal show enlargement as a compensatory mechanism lead to constant pathologicalcardiac remodeling.
1.Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
general population: Food stuffs(processed food), Drinking water, Aluminum containing medicines, Aluminum -containing products e.g., cookware, cosmetic
dialysis patients: The same as general population + Dialysis solution = Aluminum-based phosphate binders
2.What are the hazards of aluminum intoxication in the dialysis population? Osteomalacia, Low PTH, Anemia, Increased EPO needs, Dialysis encephalopathy, Increased mortality.
3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis? No clear explanation
May be aluminum-containing medicines or aluminum-containing food or during culinary preparation
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients? Cardiotoxicity, Cardiomyopathy, All-cause mortality
1-Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
In the general population,Source of aluminum in the body the foodstuffs (processed food).drinking water, and aluminum-containing medicines,
aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste)
the absorbed aluminum is excreted largely in the urine so the general population, aluminum is not bioaccumulated
In dialysis patients from dialysate tap water and medication especially Aluminum contaning phosphate binders
aluminum is bioaccumulated to a great extent in dialysis population and lead aluminum toxicity .
2-What are the hazards of aluminum intoxication in the dialysis population?
These intoxication occur when level exceed 2mic/dl causing increased cardiac mortality.associated with thrombocytosis, hypertriglyceridemia,
encephalopathy anaemia which results from ESA resistance and adynamic bone disease.
3-According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
No definit explanation but mostly due to Consumption of aluminium containing medication,Consumption of aluminium containing foods,Cooking and use of Al based cookware.
4-What is the relation between aluminum levels and cardiovascular health in dialysis patients?
From the study the patients with aberrant blood aluminum levels have higher cardiothoracic ratios than patients with normal blood aluminum levels.It is also well established that aluminum treatment causes severe cardiotoxicity and that a larger cardiothoracic ratio is linked to a higher risk of all-cause mortality in patients receiving renal replacement therapy.
Prolonged aluminum exposure led to structural changes in a myocardium that cause chronic illness
1. The dialysis patients become more aluminium from untreated water through dialysis, high quantity medication ( e.g. Epotein, heparin), aluminum containing phosphate Binders. General population get aluminium from food conservative and from cooking .
2. Aluminum serum level above 2 Mikrogramm/deziliter is considered too much.
Aluminum intoxication can cause increase cardiorhoracic index above 0.5 and this associated with increased cardiac mortality.
Associated with thrombocytosis, hypertriglyceridemia, increased iron binding capacity.
Aluminum can cause anemia, encephalopathy, low turnover bone disease, decrease PTH level.
3. Cooking in aluminum based cookware
Medication containing aluminum.
Cosmetic products .
4. Association between increased cardiorhoracic index above 0.5 and abnormal level of aluminum what is the cause of increased mortality.
In animals experiences, aluminum treatment caused structural cardiac toxicity and cardiomyopathy.
1. Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
2. What are the hazards of aluminum intoxication in the dialysis population?
3. According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
4. What is the relation between aluminum levels and cardiovascular health in dialysis patients?
In the general population,
Source of aluminum in the body
1- the foodstuffs (processed foods),
2- drinking water,
3- and aluminum-containing medicines,
4- aluminum cookware or cosmetic products (for example antiperspirants, sun creams and toothpaste)
the absorbed aluminum is excreted largely in the urine
For the general population, aluminum is not bioaccumulated to a great extent
in dialysis patients
1- dialysate
2- medication
aluminum is bioaccumulated to a great extent in dialysis population and lead aluminum toxicity and associated with medical complications such as osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs , dialysis encephalopathy and increased mortality
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1-Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
General population:
Dialysis population:
2-What are the hazards of aluminum intoxication in the dialysis population?
3-According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
4-What is the relation between aluminum levels and cardiovascular health in dialysis patients?
Patients with aberrant blood aluminum levels have higher cardiothoracic ratios than patients with normal blood aluminum levels.
It is also well established that aluminum treatment causes severe cardiotoxicity and that a larger cardiothoracic ratio is linked to a higher risk of all-cause mortality in patients receiving renal replacement therapy.
Prolonged aluminum exposure led to structural changes in a myocardium that cause chronic illness
1.Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
A.Source of aluminum for general population: inhalation, ingestion, & skin
B.Source of Aluminum for dialysis patients: Not so common these days
C.Accumulation
2.What are the hazards of aluminum intoxication in the dialysis population?
3.According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
4.What is the relation between aluminum levels and cardiovascular health in dialysis patients?
-Wide range of pathological changes in animals e.g., oxidative damage, parenchymal loss, reduced vascularity, mitochondrial swellings, & break down of collagen network. All these will results in:
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
What are the hazards of aluminum intoxication in the dialysis population?
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
Compare between general population and dialysis patients regarding the source of aluminum in the body and its accumulation.
What are the hazards of aluminum intoxication in the dialysis population?
According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
What is the relation between aluminum levels and cardiovascular health in dialysis patients?
In the general population, aluminum is commonly consumed via processed foods, drinking water, aluminum-containing pharmaceuticals, cookware, and cosmetics (for example, antiperspirants, sun creams, and toothpaste).
Food and water contain less aluminum than drugs. Aluminum enters the body by inhalation, ingestion, and skin absorption.
Dialysis patients are exceptions. Dialysis patients may accumulate aluminum via environmental, nutritional, or dialysate contamination. Chronic dialysis patients get huge amounts of dialysate; therefore, even small aluminum concentration gradients between blood and dialysate may cause significant toxicity.
osteomalacia, low levels of parathyroid hormone, anemia, increased erythropoietin needs, dialysis encephalopathy, and increased mortality.
The abnormal blood aluminum levels could possibly be explained by the consumption of aluminum-contaminated medicines, consumption of aluminum-containing foods, or aluminum contamination of food during culinary preparation.
in general population exposure to aluminum usually happens through :
oral route
foods,
drinking water.
aluminum-containing medicines
skin
cosmetic products.
inhalation
aircraft and automotive.
dialysis patients
environmental or dietary exposure or contaminated dialysate.
Chronic dialysis patients are at great odds for excess of aluminum, because they are subjected to high volumes of dialysate, and therefore even otherwise trivial concentration gradients of aluminum between blood and dialysate may produce substantial toxicity.
2- What are the hazards of aluminum intoxication in the dialysis population?
3-According to Chuang et al, what are the explanations of abnormal aluminum levels in the studied patients despite water purification by reverse osmosis?
explanation
4- What is the relation between aluminum levels and cardiovascular health in dialysis patients?
The cardiothoracic ratio was higher ( cardiomegaly) in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels .
Higher cardiothoracic ratio was associated with higher risk for all-cause mortality in patients undergoing hemodialysis and peritoneal dialysis .
cardiotoxicity with oxidative damage .
structural irregularities of myocardium, causing
At the end, the cardiac stroma exhibited a compensatory enlargement, triggering constant pathological cardiac remodeling.