Mutugi Ann, Guzzo Eduardo Cadore, Koech Matthew, Koech Maritim, Tang Jie
Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.
The Warren Alpert Medical School of Brown University, RI, USA.
Toxicol Rep. 2025 Sep 15;15:102128. doi: 10.1016/j.toxrep.2025.102128. eCollection 2025 Dec.
Aluminum is renally excreted and can cause toxicity in patients with end-stage renal disease (ESRD). In low- and middle-income countries (LMICs), potential sources of aluminum toxicity include the use of aluminum cookware and clay pots, well water, and contaminated dialysis water.
We report a case of an elderly East African woman from a rural area with ESRD who was undergoing twice-weekly hemodialysis and who presented with altered mental status. Acute cardiac and neurological events were ruled out. A head CT scan was normal. Both the infectious and metabolic workups were unremarkable. Since the patient came from a rural home where her family used clay pots, aluminum utensils, and well water for drinking, a decision was made to rule out aluminum toxicity. Serum aluminum levels were significantly elevated at 534 micrograms/L.
Aluminum toxicity based on the clinical presentation and elevated serum aluminum levels.
Daily hemodialysis with a high-flux dialyzer. Deferoxamine was not administered because of concerns about life-threatening neurotoxicity.
Her mental status started to improve within a week of initiating intensified hemodialysis. After nine months, her serum aluminum level decreased by more than 50 %, and the patient's cognition returned to her baseline.
TAKE-HOME LESSONS: ESRD patients in LMICs are at greater risk for potential aluminum toxicity than are those in developed countries. Regular testing of serum aluminum levels is necessary in these patients since the initial presentation of aluminum toxicity can be nonspecific.
铝通过肾脏排泄，可导致终末期肾病（ESRD）患者中毒。在低收入和中等收入国家（LMICs），铝中毒的潜在来源包括使用铝制炊具和陶罐、井水以及受污染的透析用水。
我们报告一例来自东非农村地区的老年女性ESRD患者，她每周接受两次血液透析，出现精神状态改变。排除了急性心脏和神经事件。头部CT扫描正常。感染和代谢检查均无异常。由于患者来自农村家庭，其家人使用陶罐、铝制餐具和井水饮用，因此决定排除铝中毒。血清铝水平显著升高，为534微克/升。
根据临床表现和血清铝水平升高诊断为铝中毒。
使用高通量透析器进行每日血液透析。由于担心危及生命的神经毒性，未给予去铁胺。
强化血液透析开始后一周内，她的精神状态开始改善。九个月后，她的血清铝水平下降超过50%，患者的认知恢复到基线水平。
与发达国家的患者相比，LMICs中的ESRD患者发生潜在铝中毒的风险更高。由于铝中毒的初始表现可能不具特异性，因此对这些患者进行血清铝水平的定期检测是必要的。
