Alüminyum Nörotoksisitesi ve Kanıta Dayalı Tedavi Bakım Uygulamaları
Özet
Alüminyum nörotoksisitesi, hemodiyaliz hastalarında bozulmuş renal eliminasyon ve iatrojenik maruziyetlerin birleşmesiyle ortaya çıkan, nörolojik, hematolojik ve iskelet sistemini etkileyen ciddi bir tablodur. Modern su arıtma teknolojileri prevalansı azaltsa da su kalitesi sorunları, sitrat kullanımı ve Al içeren preparatlar riski sürdürmektedir. Tanılama, öncelikle serum alüminyum düzeylerinin değerlendirilmesine dayanır; klinik tabloyu destekleyen durumlarda ise DFO stimülasyon testi veya kemik biyopsisi ile doku birikimi daha hassas biçimde ortaya konur. Tedavi süreci, maruziyet kaynaklarının titizlikle ortadan kaldırılması ve uygun şelasyon protokollerinin destekleyici bakım uygulamalarıyla bütünleştirilmesiyle yürütülür. Bu süreçte hemşirelik bakımı, erken klinik değişikliklerin fark edilmesi, tedavi yanıtının izlenmesi ve olası komplikasyonların önlenmesinde kritik bir öneme sahiptir.
Referanslar
Qunibi WY. Aluminum toxicity in chronic kidney disease. In: Berns JS, (section editor), Taylor EN (deputy editor). UpToDate. Waltham, MA: UpToDate Inc.; Literature review current through Oct 2025. Topic last updated Oct 10, 2025.
Seidowsky A, Dupuis E, Drueke T, Dard S, Massy ZA, Canaud B. [Aluminic intoxication in chronic hemodialysis. A diagnosis rarely evoked nowadays. Clinical case and review of the literature]. Nephrol Ther. 2018;14(1):35–41. doi:10.1016/j.nephro.2017.04.002.
Oliveira RB, Barreto FC, Nunes LA, Custódio MR. Aluminum intoxication in chronic kidney disease. J Bras Nefrol. 2021;43(4 Suppl 1):660–664. doi:10.1590/2175-8239-JBN-2021-S110.
Chuang YF, Wang TH, Chang MY, Huang JF, Tsai PC, Yang WC, et al. Serum aluminum levels and association with mortality, cardiovascular events, and mineral bone disorder in dialysis patients. Int J Environ Res Public Health. 2022;19(7):3885. doi:10.3390/ijerph19073885.
Sharma AP, Ritchie S, McRae JL, Lindsay RM, Zimmerman DL, Pandeya S, et al. Assessing the utility of testing aluminum levels in dialysis patients. Hemodial Int. 2015;19(2):256–262. doi:10.1111/hdi.12231.
Tsai MH, Fang YW, Liou HH, Leu JG, Lin BS. Association of serum aluminum levels with mortality in patients on chronic hemodialysis. Sci Rep. 2018;8:16729. doi:10.1038/s41598-018-34799-5.
Chen MY, Chen CH, Lin HM, Shiao CC, Liu CF, Tsai YC, et al. Aluminum overload in the reverse osmosis dialysis era: does it exist? Ren Fail. 2022;44(1):1596–1604. doi:10.1080/0886022X.2022.2104165.
Keser A, Tunçer E. Böbrek hastalıkları ve mikro besin ögeleri. Bes Diy Derg. 2018;46(Suppl):18–29. doi:10.33076/2018.BDD.1167.
Rahimzadeh MR, Rahimzadeh MR, Kazemi S, Moghadamnia AA. Aluminium poisoning with emphasis on its mechanism and treatment of intoxication. Emerg Med Int. 2022;2022:1480553. doi:10.1155/2022/1480553.
Brylinski L, Hong SM, Fan J, Song P, Wu D, Zhang H, et al. Serum aluminum and cognitive function in hemodialysis patients. Int J Mol Sci. 2023;24(8):7228. doi:10.3390/ijms24087228.
Igbokwe IO, Igwenagu E, Igbokwe NA. Aluminium toxicosis: a review of toxic actions and effects. Interdiscip Toxicol. 2019;12(2):45–70. doi:10.2478/intox-2019-0007.
Sarhan II, Tawfik AM, El Said TW, Abd El Aziz Abd El Azim MN, Sayed Hussein H. Relation of serum aluminum level to uremic pruritus in end-stage renal disease patients on maintenance hemodialysis. J Nephropathol. 2023;12(4):e17350. doi:10.34172/jnp.2022.17350.
Jackson JS, Rout P. Aluminum Toxicity. [Updated 2024 Oct 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK609094/
Renke G, Almeida VBP, Souza EA, Lessa S, Teixeira RL, Rocha L, et al. Clinical outcomes of the deleterious effects of aluminum on neuro-cognition, inflammation, and health: a review. Nutrients. 2023;15(9):2221. doi:10.3390/nu15092221.
Almeida ARLP, Oliveira FA, Costa LEL, Alves MB, Sousa AR, Silva RS. Nursing interventions for people undergoing hemodialysis treatment: content validity. Rev. Eletr. Enferm. 2024;26:76073.
Coulson JM, Fryer AA, Strang-Karlsson S, Steel L, Sturtevant JM, Coneyworth LJ, et al. Dose–response relationships in aluminium toxicity in humans. Clin Toxicol (Phila). 2022;60(4):415–428. doi:10.1080/15563650.2022.2029879.
Friesen MS, Purssell RA, Gair RD. Aluminum toxicity following IV use of oral methadone solution. Clin Toxicol (Phila). 2006;44(3):307–314. doi:10.1080/15563650600637077.
Oruc M, Asan F, Mercan S, Kose S, Kirpinar MM, Poyraz BC, et al. Association between trace elements and cognitive function among hemodialysis patients in Turkey. Hemodial Int. 2025;29(1):93–107. doi:10.1111/hdi.13188.
Kawahara M, Kato-Negishi M. Link between aluminum and the pathogenesis of Alzheimer’s disease: the integration of the aluminum and amyloid cascade hypotheses. Int J Alzheimers Dis. 2011;2011:276393. doi:10.4061/2011/276393.
Hsu CW, Weng CH, Chan MJ, Lin-Tan DT, Yen TH, Huang WH. Association between serum aluminum level and uremic pruritus in hemodialysis patients. Sci Rep. 2018;8:17251. doi:10.1038/s41598-018-35217-6.
Mardini J, Lavergne V, Ghannoum M. Aluminum transfer during dialysis: a systematic review. Int Urol Nephrol. 2014;46:1361–1365. doi:10.1007/s11255-014-0752-8.
Warady BA, Schaefer F, Alexander SR, editors. Pediatric dialysis. 2nd ed. New York: Springer; 2012.
Alipour Shirazi O, Esmaeili R, Zakariaei Z, Hosseini-Nejad M, Moosazadeh M, Alijanpour S. Advancing pre-hospital emergency nursing care: Formulating a clinical protocol for aluminum phosphide poisoning (CPALP). Nurs Midwifery Stud. 2025;14(3):162-73.
Chou CY, Wu TT, Chang CY, Chen TJ, Chang CT, Huang CC. Longer dialysis times are associated with a lower chance of dementia among chronic hemodialysis patients. Ther Apher Dial. 2015;19(1):50–55.
Kanbay M, Mizrak B, Copur S, Basile C. Cognitive impairment in patients on dialysis: can we prevent it? J Nephrol. 2024;37:1813–1820. doi:10.1007/s40620-024-02093-5.
Chen Z, Ma J, Ou H, Pu L. Impact of nursing interventions on hemodialysis patients using the integrated theory of health behavior change. Medicine 2025;104:2(e41050).
