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

Worldwide, environmental pollution is a leading cause of illness and mortality. This includes heavy metals, air pollutants, agricultural pesticides, and polluted food and water. Various factors, such as impaired renal excretion, degree of renal impairment, medication use, dialysate contamination, quality of the dialysis water, and metabolic changes in those suffering with end-stage kidney disease, may lead to heavy metal accumulation in hemodialysis patients. The study aimed to assess heavy metal toxicity levels in adults on hemodialysis compared to a control group and to investigate the correlation between parathyroid hormone (PTH) and heavy metal levels, uremic pruritus, and anemia. Method: Cross-sectional research involving 60 adult patients was conducted on regular hemodialysis for at least three months. As a control group, there were 60 adult volunteers who matched in age and sex with the patient group. The Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method was used to examine the concentrations of heavy metals in drinking water and dialysate water for both groups, including serum levels of aluminum (Al), lead (Pb), cadmium (Cd), chromium (Cr), and arsenic (As). Result: The hemodialysis group had greater levels of Al, Pb, Cd, Cr, and As than the control group. Serum lead levels and PTH and serum ferritin and chromium levels were significantly correlated negatively. There was no significant correlation between heavy metal levels with uremic pruritus and anemia. Heavy metals in dialysis and drinking water samples were within acceptable ranges, and they were below the detection limit according to WHO and Association for the Advancement of Medical Instrumentation/American National Standards Institute (AAMI/ANSI). Elevated heavy metal levels might not be primarily caused by drinking water or dialysis.