Aluminium

General Information

Toxicity

Aluminium toxicity mainly arises in patients with chronic renal failure who are undergoing treatment either by conservative means or by maintenance haemo or peritoneal dialysis. Greatly elevated serum aluminium concentrations in these patients are clearly associated with the symptoms of dialysis encephalopathy (speech disorder, dementia, convulsions and death) and dialysis osteodystrophy (osteomalacia frequently resistant to treatment with vitamin D or its active metabolites). Aluminium accumulation may be responsible, in part at least, for the anaemia and soft tissue calcification of chronic renal failure. High concentrations may also be cardiotoxic.

The increased body burden comes from two sources.

1. Firstly, oral aluminium hydroxide is widely used as a phosphate binder, and the normal intestinal absorption may be enhanced in chronic renal failure.
2. Secondly, dialysis fluid may have a high aluminium content arising from impurities in the salts used in its manufacture,  the containers in which it is stored or  from the preparation of the fluid by dilution of a concentrate with water having a naturally high aluminium concentration, or to which aluminium has been added by the local Water Authority as a flocculent to remove coloured matter. Increasing use of reverse osmosis for water purification has greatly reduced intake from this source, leaving oral aluminium as the main hazard.

The aluminium content of certain blood products and intravenous fluids may pose a considerable risk to individuals receiving them on a long term basis, particularly premature infants in whom renal function may be impaired.

Also, rare occupational exposure from working in factories and warehouses where aluminium is  produced or welding takes place may increase exposure. Occupational exposure to dust containing finely divided aluminium may cause pulmonary fibrosis. It has been suggested that uptake of aluminium into brain may be responsible for the symptoms of Alzheimer’s disease.

Deficiency

Aluminium is a non-essential trace element with little known about its biological function. There has been no known cases of Aluminium deficiency and its measurement in this situation is not required.