The enigma of aluminum deposition in bone tissue from a patient with chronic kidney disease: a case report

ABSTRACT About four decades ago, the relationship between dialysis-dementia and aluminum (Al) began to be established. The restriction of drugs containing Al and improvements on water quality used for dialysis resulted in the clinical disappearance of Al intoxication. However, high prevalence of Al deposition in bone tissue from Brazilian dialysis patients is still being detected. Through the case report of a patient on hemodialysis (HD) for one year, presenting significant Al deposition in bone tissue, we speculated if this problem is not being underestimated. We used extensive investigation to identify potential sources of Al exposure with a careful review of medication history and water quality controls. Al concentration was measured by different methods, including mass spectrometry, in poly-electrolyte concentrate solutions and solution for peritoneal dialysis, in an attempt to elucidate the possible sources of contamination. The objective of this case report is to alert the medical community about a potential high prevalence of Al deposition in bone tissue and to discuss the possible sources of contamination in patients with chronic kidney disease (CKD).

摘要：约四十年前，透析相关性痴呆与铝（Aluminum, Al）的关联逐步得以确立。通过管控含铝药物、优化透析用水水质，铝中毒已在临床中销声匿迹。然而，目前仍有研究在巴西透析患者的骨组织中检出高比例的铝沉积情况。本研究依托一例接受血液透析（Hemodialysis, HD）满一年、骨组织存在显著铝沉积的患者病例，推测该问题可能未得到足够重视。我们通过细致回顾患者用药史与水质管控记录，开展全面调查以明确铝暴露的潜在来源。我们采用包括质谱法在内的多种检测手段，对多电解质浓缩液与腹膜透析液中的铝浓度进行测定，以期阐明污染的潜在来源。本病例报告旨在提醒医学界警惕慢性肾病（Chronic Kidney Disease, CKD）患者骨组织铝沉积的潜在高患病率，并探讨此类患者的污染潜在来源。