Abstract
The safety of fluoridated community water supplies for dialysate and long-term intermittent hemodialysis has been questioned since 1965 [1]. The only significant means of clearing fluoride from body fluids are renal excretion and incorporation into bone [2]. When dialysate is prepared with fluoridated water, fluoride ion moves along a concentration gradient from dialysate to blood [3, 4]. Because rental excretion is defective or absent in such patients, the fluoride administered during dialysis is incorporated into the skeleton. Under these conditions, serum fluoride concentrations increase progressively, and the bone content of fluoride rises above values obtained in persons with normal renal function who drink water that is fluoridated [3-6] (the serumfluroride concentraiton in normal persons who drink water with a fluoride concentration of 5µm [1 ppm] is 0.7 +-.4µm [mean +-SD]. Although it has not been established that fluoridated dialysate adversely affects the bone of patients maintained by hemodialysis, this possibility exists, particularly in patients who have been exposed to such a dialysate for many years. This and other problems associated with various substances in tap water may actually increase as the deionizer becomes exhausted.
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Effects of fluoride on bone metabolism in patients with hemodialysis
The maior pathway of fluoride elimination from the human body is the kidney. The discharge of fluoride into urine depends on the clearance of the kidney. Fluoride in serum of hemodialysis patients is higher than that of healthy subjects. Fluoride is not reduced sufficiently with hemodialysis. Those patients are in
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High fluoride concentrations in the serum and bone of patients with chronic renal failure
The aim was to study the effect of ingested fluoride in patients with chronic renal failure (CRF). Serum fluoride concentrations were measured in 104 subjects, who formed three groups: nondialyzed CRF, dialyzed CRF, and a control group. The iliac bone fluoride was measured in 20 subjects. Serum, urine and water
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Renal osteodystrophy in patients on long-term hemodialysis with fluoridated water
Serum and bone fluoride concentrations of ten patients maintained on long-term hemodialysis with fluoridated water (1 ppm, i.e., 50uM) were correlated with duration of treatment and the occurrence of clinical, radiological, and histological manifestations of bone disease. Two patients had symptomatic renal osteodystrophy when accepted on the program, whereas six
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Exposure to excessive fluoride during hemodialysis
Discussion These data indicate that a patient maintained by hemodialysis in a community using fluoridated water may be exposed to a fluoride concentration higher than that present in tap water if the deionizer is allowed to become exhausted while the patient is being dialyzed. The concentration reached 520 uM in the
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High fluoride exposure in hemodialysis patients
The observation of higher plasma flouride levels in our hemodialysis (HD) patients than our continuous ambulatory peritoneal dialysis (CAPD) patients (4.0 +/- 0.5 mumol/L [n = 17] v 2.5 +/- 0.3 mumol/L [n = 17], P less than 0.005) prompted an evaluation of fluoride metabolism during HD. We found that
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Fluoride & Osteomalacia
One of fluoride's most well-defined effects on bone tissue is it's ability to increase the osteoid content of bone. Osteoid is unmineralized bone tissue. When bones have too much of it, they become soft and prone to fracture -- a condition known as osteomalacia. As shown below, fluoride has repeatedly been
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Fluoridation of drinking water and chronic kidney disease: Absence of evidence is not evidence of absence
A fairly substantial body of research indicates that patients with chronic renal insufficiency are at an increased risk of chronic fluoride toxicity. Patients with reduced glomerular filtration rates have a decreased ability to excrete fluoride in the urine. These patients may develop skeletal fluorosis even at 1 ppm fluoride in the drinking water.
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Skeletal Fluorosis in the U.S.
Although there has been a notable absence of systematic studies on skeletal fluorosis in the U.S., the available evidence indicates that the consumption of artificially fluoridated water is likely to cause skeletal fluorosis and other forms of bone disease in people with kidney disease and other vulnerable populations.
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Mayo Clinic: Fluoridation & Bone Disease in Renal Patients
The available evidence suggests that some patients wtih long-term renal failure are being affected by drinking water with as little as 2 ppm fluoride. The finding of adverse effects in patients drinking water with 2 ppm of fluoride suggests that a few similar cases may be found in patients imbibing 1 ppm, especially if large volumes are consumed, or in heavy tea drinkers. The finding of adverse effects in patients drinking water with 2 ppm of fluoride suggests that a few similar cases may be found in patients imbibing 1 ppm, especially if large volumes are consumed, or in heavy tea drinkers and if fluoride is indeed the cause. It would seem prudent, therefore, to monitor the fluoride intake of patients with renal failure living in high fluoride areas.
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Similarities between Skeletal Fluorosis and Renal Osteodystrophy
It is quite possible, and indeed likely, that some kidney patients diagnosed with renal osteodystrophy are either suffering from skeletal fluorosis or their condition is being complicated/exacerbated by fluoride exposure.
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