Dialysis Dementia Aluminium Neurotoxicity — ESENeph MCQ

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HardHaemodialysisDialysis Dementia Aluminium NeurotoxicityESENeph

A 58-year-old man on haemodialysis develops progressive cognitive decline, speech apraxia, and myoclonus over 6 months. He has been on dialysis for 15 years at a centre that recently identified elevated aluminium levels in the water treatment system. Serum aluminium is 180 ug/L (normal <20). What is the diagnosis?

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Correct answer: A — Dialysis dementia (aluminium neurotoxicity)

Dialysis dementia (dialysis encephalopathy) is caused by chronic aluminium accumulation, historically from aluminium-containing phosphate binders or contaminated dialysis water. Clinical features progress through speech disturbance (stuttering, dysarthria), myoclonus, seizures, personality change, and terminal dementia. Serum aluminium >60 ug/L is concerning; >200 ug/L confirms toxic levels. Modern water purification (reverse osmosis) has made this rare, but equipment failures can cause outbreaks. Treatment: stop aluminium exposure, desferrioxamine chelation (binds aluminium for removal during dialysis). Prevention: strict water quality monitoring per ISO 23500 standards (aluminium <10 ug/L in dialysate).

Reference: Alfrey et al 1976 – Dialysis Dementia; UKKA 2019 – Water Treatment Standards