Dialysis dementia treatment

The neurotoxic effects of aluminum were first observed in people undergoing dialysis for treatment of kidney failure. This syndrome, called dialysis dementia, starts with speech disorders and progresses to dementia and convulsions. Symptoms corresponded with elevated aluminum levels commonly found in bone, brain, and muscle following 3 to 7 years of treatment. Elevated levels of aluminum were also found in the brains of people suffering from Alzheimer s disease. Despite considerable research, it is not clear if the aluminum accumulation in the brain is a cause of Alzheimer s disease or a result of changes in the brain associated with the disease. 

Elevated aluminum levels have been implicated as the cause of dialysis encephalopathy or dementia in renal failure patients undergoing long-term hemodialysis [85]. Some patients used aluminum-containing medications. Moreover, patients with renal failure cannot remove aluminum from the blood. Dialysis dementia can arise after three to seven years of hemodialysis treatment. Speech disorders precede dementia and convulsions. Since many hemodialysis units rely on systems to purify fluoridated tap water, it is likely that many patients are being exposed inadvertently to increased concentrations of fluoride and aluminum. Increased serum fluoride concentration and fluoride intoxication have been also observed in chronic hemodialysis patients. Arnow et al. [96] reported that 12 of 15 patients receiving dialysis treatment in one room became acutely ill, with multiple non-specific symptoms and fatal ventricular fibrillation. Death was associated with longer hemodialysis time and increased age compared with other patients who became ill. 

Sherrard DJ, Walker JV, Boykin JL. Precipitation of dialysis dementia by deferoxamine treatment of aluminum-related bone disease. Am J Kidney Dis 1988 12(2) 126-30. 

Davison AM, Walker GS, Oli H, et al Water supply aluminium concentration, dialysis dementia, and effect of reverse-osmosis water treatment. Lancet 2 785-787,1982 Dettori P, LaGreca G, Biasioli S, et al Changes of cerebral density in dialyzed patients. Neuroradiology 23 95-99, 1982... 

In summary, dialysis dementia probably represents an end point in a disease of multiple etiology. There are at least three subgroups and in two of them the etiology of dialysis encephalopathy must be regarded as unknown. The possible role of aluminum, or other trace element abnormalities, is unclear. At this time, there is no known satisfactory treatment for patients with dialysis encephalopathy. Most patients reported in the literature thus far have not survived, usually dying within 18 months of the time of diagnosis. The syndrome is not alleviated by increased... 

Several factors have implicated the role of increased cdumi-num in this disease. Alfrey et al. reported elevated aluminum levels in muscle, bone, and brain gray matter in dialysis patients, suggesting that eduminum was the etiological agent in dialysis dementia. McDermott and Smith correlated the duration of dialysis treatment, using softened or untreated tap water to make up the dialyzate, with the brain aluminum level in dialysis dementia patients. Several investigators have shown that dialysis dementia is associated with high aluminum content in the water used to make up the dialyzate Further, elimination or reduction of the dementia is observed when deionized water is substituted. Several authors also observed a reversal of dialysis dementia when oral aluminum hydroxide intake was stopped. ... 

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