Aluminium toxicity in dialysis patients: no evidence for a threshold serum aluminium concentration

1993 ◽  
Vol 8 (supp1) ◽  
pp. 25-34 ◽  
Author(s):  
P. Altmann
BMJ ◽  
1985 ◽  
Vol 290 (6482) ◽  
pp. 1613-1614 ◽  
Author(s):  
S A Charhon ◽  
P M Chavassieux ◽  
P J Meunier ◽  
M Accominotti

The Lancet ◽  
1994 ◽  
Vol 343 (8889) ◽  
pp. 122-123 ◽  
Author(s):  
IbrahimH. Fahal ◽  
Muhammad Yaqoob ◽  
PeterS. Williams ◽  
Rasheed Ahmad ◽  
NormanB. Roberts ◽  
...  

1980 ◽  
Vol 31 (1) ◽  
pp. 61 ◽  
Author(s):  
MMde Carvalho ◽  
CS Andrew ◽  
DG Edwards ◽  
CJ Asher ◽  
Carvalho MM De

The yield rcsponse of six Stylosanthes species to a factorial combination of four lime rates and two phosphorus levels applied to three acid soils (Coolum, Kogan, Rochedale) was determined in a pot experiment. The unlimed soils were of similar pH, but differed widely in exchangeable aluminium content. Aluminium toxicity appeared to be a major limitation to growth in the three soils. In the unlimed soils, the most severe yield restriction was observed in the Coolum soil, which had the highest soluble aluminium concentration (55 �M), and the least restriction in the Kogan soil, which had the lowest soluble aluminium concentration (37 �M). All six species achieved maximum yield in the three soils when the soluble aluminium concentration was reduced to values below 21 �M . The strong yield responses observed with little change in soluble aluminium at the higher lime rates in the Coolum and Rochedale soils may be due to either a further reduction in aluminium toxicity associated with increasing concentration of soluble polymeric species or the direct alleviation of hydrogen ion toxicity. The observed responses to lime do not appear to involve direct calcium effects, nor do they involve alleviation of manganese toxicity or molybdenum deficiency. Maximum yield was associated with reduction in aluminium saturation to less than 5% of the effective cation exchange capacity in all three soils. However, when examined across the three soils, aluminium saturation and also the exchangeable aluminium content were both unsatisfactory predictors of plant performance. The largest and smallest restrictions on growth were observed in soils with similar aluminium saturation (Coolum 14.4%, Kogan 17.6% respectively), while the Rochedale soil with its much higher aluminium saturation (42.0%) was intermediate in degree of growth restriction. Phosphorus and nitrogen deficiencies also limited plant growth, but the magnitude of their effects varied among soils and species.


Pteridines ◽  
1989 ◽  
Vol 1 (2) ◽  
pp. 111-117
Author(s):  
Paul Altmann ◽  
Nick Sawyer ◽  
John Cunningham ◽  
Frank Marsh ◽  
Chris Hamon ◽  
...  

Summary Patients undertaking maintenance haemodialysis may develop a variety of neurological disorders, the most serious of which is aluminium induced encephalopathy. Abnormally raised serum concentrations of pterins are found in dialysis patients, and neonates with tetrahydrobiopterin deficiency develop mental dysfunction. Dihydropteridine reductase, essential for maintenance of normal levels of tetrahydrobiopterin, is inhibited when aluminium is added to brain homogenate at similar concentrations to those found in aluminium encephalopathy. We have previously shown that erythrocyte dihydropteridine reductase activity was reduced in non-encephalopathic dialysis patients and inversely related to serum aluminium concentration. Concentrations of serum biopterin derivatives were raised but not related to either aluminium or dihydropteridine reductase. In this study of 17 haemodialysis patients, serum biopterin (13.6 ± 1.3 μg/l) and neopterin (66.2 ± 7.4 μg/l) concentrations were raised compared with normal subjects' biopterin (2.4 ± 0.4 g/l) and neopterin (2.8 ± 0.4 μg/l) values (p = 0.0001). When neopterin and biopterin concentrations were corrected for predialysis serum creatinine a weak relationship appeared between them (r = 0.49, P = 0.04). Erythrocyte dihydropteridine reductase was not related to the creatinine corrected neopterin (r = -0.5, p = 0.2), but there was a significant relationship between DHPR and corrected biopterin (r = 0.986, p = 0.0001) and between corrected biopterin and bone aluminium content (r = 0.68, P = 0.03). Our results support the possibility that aluminium causes changes in pterin metabolism which are analogous to those found in Type II hyperphenylalaninaemia. Serum biopterin concentration, corrected for pre-dialysis serum creatinine, can be used satisfactorily to study tetrahydrobiopterin metabolism in haemodialysis patients. However neopterin/biopterin ratios are unpredictably disturbed and cannot be so used. Serum neopterin concentrations are raised more than anticipated from the biopterin concentrations, and this may be due to neopterin release from macrophages activated by dialysis membranes and/or reduced conversion of dihydroneopterin triphosphate to tetrahydrobiopterin.


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