The Aluminum Company Case Study

From the available literature it is impossible to have a proper evaluation of the aluminum levels in the water used for dialysis, the serum levels in patients and their outcome, due to insufficient data and retrospective studies. Water aluminum values can vary substantially over a short period, and some water companies may either be reluctant to release their data, or did not test aluminum on a frequent basis. There have been only two outbreaks of acute encephalopathy one in Portugal, and one on Curasao with similar symptomatology and a mortality above 30%. In both studies aluminum levels in the water used for dialysis was measured after the outbreak and in both studies levels above 650 pg/L were found. In several cases levels above 1000 pg/L, and retrospectively calculated up to 8400 pg/L were reported, without similar clinical symptoms. Because acute aluminum encephalopathy has been extremely rare and with regard to the fact that patients seem to tolerate extremely high serum levels (above 1000 pg/L) before acute aluminum encephalopathy develops, it seems likely that in outbreaks in hemodialysis, levels of the water used for dialysis need to be at least above 1000 to 1500 pg/L before acute aluminum encephalopathy can develop. 

A large number of epidemiology and case-control studies have examined the potential association between oral aluminum exposure and Alzheimer s disease. A number of these studies have been criticized for flawed patient selection, poor comparability of exposed and control groups, poor exposure assessment, poor assessment of health outcomes, and weak statistical correlations (Nieboer et al. 1995 Schupf et al. 1989). Studies conducted by Martyn et al. (1989), McLachlan et al. (1996), and Michel et al. (1990) have found an association between oral exposure to aluminum and an increased risk of Alzheimer s disease. In a survey study conducted by Martyn et al. (1989), the incidence of Alzheimer s disease in individuals under the age of 70 was estimated from computerized tomographic (CT) records. The 1,203 subjects lived in 88 county districts within England and Wales. Data on aluminum concentrations in the municipal water over a 10-year period were obtained from water authorities and water companies. The subjects were classified as having probable Alzheimer s disease, possible Alzheimer s disease, other causes of dementia, or epilepsy. The relative risks of Alzheimer s disease were elevated in the subjects living in districts with aluminum water concentrations of >0.01 mg/L. However, the relative risk exceeded unity only in the subjects with aluminum water concentrations of >0.11 mg/L (relative risk of 1.5, 95% confidence interval of 1.1-2.2). 

Shaver and Riddell (1947) found 35 cases (10%) of pulmonary fibrosis out of 344 aluminum pot room workers. Studies from Germanyrevealedthat26%of628 workers had roentgenographic evidence of pneumoconiosis (Mitchell et al. 1961). In one study, the authors reported that small irregular opacities were observed in 7-8% of 788 male employees of an aluminum production company (Townsend et al. 1988). Jederlinic et al. (1990) found a 1% incidence of interstitial fibrosis in a factory using alumina as an abrasive. 

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