ABSTRACT
The role of aluminum as a causative agent of encephalopathy in uremic patients on haemodialysis, and the effect of lowering serum aluminum level by the chelating agent deferoxamine [DFO] in improving clinical and electroencephalographic [EEG] features of dialysis encephalopathy [DE] was evaluated in eight patients with dE. This work was carried out on [10] control persons and [32] uremic adult patients on hemodialysis [HD] and receiving aluminum containing phosphate binder to prevent hyperphosphatemia. Patients were divided into three subgroups according to the duration of haemodialysis. The first subgroup [10] patients who have been on [HD] for a period up to 6 months. Second subgroup [10] patients who have been on HD for 6-12 months. The third subgroup [12] were on [HD] for more than 12 months up to 6 years. All patients underwent neurological examination and a waking EEG. We diagnosed dE only in the presence of the typical EEG, charges with or without manifest clinical symptoms. Thirteen [20%] patients under study showed clinical and/or typical EEG signs of DE. Five of the 13 patients developed serious clinical deterioration which led to death of four of them. Four of the remaining patients with DE showed both clinical and EEG signs, while the remaining four showed only EEG signs. Comparatively the serum alminum [SAL] level in patients with dE was significantly higher than in patients without neurologic dysfunction [p<0.05]. After the DFO infusion test, there was a significant high increase in SAL levels in DE patients when compared with those without [t = 5.4, P<0.05]. In our patients with SAL over 100 micro g/L the prevalence of DE was unexpectedly high when this neurological disorder was carefully investigated. We conclude that regular and continuous monitoring of SAL levels both basal and after DFO test, is of considerable value in detecting those patients at risk for DE and that regular EEG recordings, at least every six months, for all patients with serum level > 100 micro g/L is a sensitive method of detecting subclinical DE. Although DFO therapy has been applied to a limited number of patients in this study, we believe that it offers an effective treatment for DE, hoping that this disorder be a disease of the past