# Assessment of Potential Toxic Heavy Metal Levels in Serum of Saudi Patients Under Regular Hemodialysis and Its Association with Parathyroid Hormone, Uremic Pruritus, and Anemia

## TL;DR

This study found higher levels of toxic heavy metals in hemodialysis patients compared to healthy controls, but these levels were not linked to water sources or specific symptoms like pruritus or anemia.

## Contribution

The study provides new insights into the sources and correlations of toxic heavy metal accumulation in hemodialysis patients.

## Key findings

- Hemodialysis patients had significantly higher levels of aluminum, lead, cadmium, chromium, and arsenic than controls.
- Serum lead levels were negatively correlated with parathyroid hormone, and serum ferritin was negatively correlated with chromium.
- Toxic element levels in dialysis and drinking water were within safe limits set by WHO and AAMI/ANSI.

## Abstract

Worldwide, environmental pollution is a major contributor to illness and mortality, encompassing toxic elements, air pollutants, agricultural pesticides, and contaminated food and water. In patients with end-stage kidney disease, several factors—including impaired renal excretion, the degree of renal impairment, medication use, dialysate contamination, the quality of dialysis water, and metabolic changes—may lead to the accumulation of toxic elements in hemodialysis patients. This study aimed to assess toxic element levels in adults undergoing hemodialysis compared to a control group and to investigate the correlation between parathyroid hormone (PTH) levels, uremic pruritus, anemia and toxic element concentrations. A cross-sectional study was conducted on 60 adult patients undergoing regular hemodialysis for at least three months. Another group of 60 apparently healthy adult voluntaries with matched age and sex with the patient group served as the control. The Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method was used to measure the concentrations of serum levels of aluminum (Al), lead (Pb), cadmium (Cd), chromium (Cr), and arsenic (As) for both groups, as well as in drinking water and dialysate water. The hemodialysis group exhibited significantly higher levels of Al, Pb, Cd, Cr, and As compared to the control group. Serum Pb levels showed a significant negative correlation with PTH, while serum ferritin levels were negatively correlated with Cr. However, no significant correlation was found between toxic element levels and uremic pruritus or anemia. Toxic element concentrations in dialysis and drinking water samples were within acceptable limits and below the detection threshold set by the World Health Organization (WHO) and the Association for the Advancement of Medical Instrumentation/American National Standards Institute (AAMI/ANSI). Therefore, elevated toxic element levels in hemodialysis patients may not be primarily attributable to drinking water or dialysis.