维持性血液透析患者使用铝制炊具做饭与慢性铝中毒的关系：一项病例对照研究。

Relationship between the Use of Aluminium Utensils for Cooking Meals and Chronic Aluminum Toxicity in Patients on Maintenance Hemodialysis: A Case Control Study.

作者信息

Bichu Shrirang, Tilve Parag, Kakde Pranit, Jain Pranesh, Khurana Shweta, Ukirade Vinayak, Jawandhiya Pankaj, Dixit Abhishek, Bhasin Nikhil, Billa Viswanath, Kumar Rajesh, Kothari Jatin

机构信息

Professor and Head, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra;Corresponding Author.

Assistant Nephrologist, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra.

出版信息

J Assoc Physicians India. 2019 Apr;67(4):52-56.

PMID:31309799

Abstract

BACKGROUND

Chronic aluminum toxicity (CAT) in end stage kidney disease (ESKD) patients is now a rare clinical disorder, unlike in the past, because of improvements in hemodialysis water purification systems and discontinuation of use of aluminum hydroxide as a phosphate binder. The use of aluminum utensils for cooking could be an unrecognised cause of the CAT.

OBJECTIVE

To assess the association between aluminum kitchen utensils used for cooking meals and chronic aluminum toxicity (CAT) in patients on maintenance hemodialysis (MHD).

MATERIAL AND METHODS

In this case control study, a total of 31 (cases n=10; controls n=21) patients on MHD for more than one year were included. Cases were defined as patients with clinical manifestations (including laboratory parameters) of CAT and high (>200 mcg/L) serum aluminum levels. Control group was chosen from the same hemodialysis facilities. Association between use of aluminum utensils for cooking and occurrence of CAT was assessed.

RESULTS

The mean age of patients in the cases and the control group was 52.90 and 52.95 years respectively with on significant difference (p=0.99). There was no difference in mean duration of dialysis (p=0.78), serum calcium level (p=0.06), serum phosphate level (p=0.19), serum albumin level (p=0.06), history of hypertension (p=1.00) and history of diabetes (n=0.12) between two groups. Mean haemoglobin (p<0.05) and mean iPTH (p<0.05) was significantly lower in the cases as compared to control group. Thirteen patients had history of use of aluminum utensils [cases 10 (76.90%) and control 3 (23.10%); p<0.05]. All cases i.e. 10 (100%) had exposure to aluminum utensils whereas three (14.3%) patients in the control group had exposure to aluminum utensils whereas 18 (85.7%) patients had no exposure. The relative risk of having CAT because of use of aluminum utensils compared to not using was 28.46 (1.81 to 445.3) and the odd's ratio estimated was 120 (5.45 to 2642).

CONCLUSION

Use of aluminum utensils for cooking meals is associated with CAT. Larger studies are required to confirm these findings.

摘要

背景

与过去不同，由于血液透析水净化系统的改进以及氢氧化铝作为磷结合剂的停用，终末期肾病（ESKD）患者中的慢性铝中毒（CAT）现在是一种罕见的临床病症。使用铝制炊具烹饪可能是未被认识到的慢性铝中毒病因。

目的

评估用于烹饪膳食的铝制厨房用具与维持性血液透析（MHD）患者慢性铝中毒（CAT）之间的关联。

材料与方法

在这项病例对照研究中，纳入了31例（病例组n = 10；对照组n = 21）接受MHD超过一年的患者。病例定义为具有慢性铝中毒临床表现（包括实验室参数）且血清铝水平高（>200 mcg/L）的患者。对照组选自同一血液透析机构。评估使用铝制炊具烹饪与慢性铝中毒发生之间的关联。

结果

病例组和对照组患者的平均年龄分别为52.90岁和52.95岁，无显著差异（p = 0.99）。两组间的平均透析时长（p = 0.78）、血清钙水平（p = 0.06）、血清磷水平（p = 0.19）、血清白蛋白水平（p = 0.06）、高血压病史（p = 1.00）和糖尿病病史（p = 0.12）均无差异。与对照组相比，病例组的平均血红蛋白（p<0.05）和平均全段甲状旁腺激素（p<0.05）显著更低。13例患者有使用铝制炊具的历史[病例组10例（76.90%），对照组3例（23.10%）；p<0.05]。所有病例即10例（100%）都接触过铝制炊具，而对照组中有3例（14.3%）患者接触过铝制炊具，18例（85.7%）患者未接触过。与未使用铝制炊具相比，因使用铝制炊具而患慢性铝中毒的相对风险为28.46（1.81至445.3），估计的优势比为120（5.45至2642）。