October 1988

Relationship of Aluminum to Neurocognitive Dysfunction in Chronic Dialysis Patients

Author Affiliations

From the Departments of Medicine, Section of Nephrology (Drs Sprague and Corwin), Neurologic Sciences (Drs Tanner, Green, and Goetz), and Psychology and Social Sciences (Dr Wilson), Rush-Presbyterian-St Luke's Medical Center, Chicago. Dr Sprague is presently with the Section of Nephrology, Pritzker School of Medicine, University of Chicago.

Arch Intern Med. 1988;148(10):2169-2172. doi:10.1001/archinte.1988.00380100055012

• Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 μg/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

(Arch Intern Med 1988;148:2169-2172)