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Gembillo G, Peritore L, Labbozzetta V, Giuffrida AE, Lipari A, Spallino E, Calabrese V, Visconti L, Santoro D. Copper Serum Levels in the Hemodialysis Patient Population. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1484. [PMID: 39336525 PMCID: PMC11434394 DOI: 10.3390/medicina60091484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024]
Abstract
Copper is an essential element in the diet of mammals, including humans. It plays an important role in the physiological regulation of various enzymes and is consequently involved in several biological processes such as angiogenesis, oxidative stress regulation, neuromodulation, and erythropoiesis. Copper is essential for facilitating the transfer of iron from cells to the bloodstream, which is necessary for proper absorption of dietary iron and the distribution of iron throughout the body. In particular, patients with end-stage renal failure who require renal replacement therapy are at increased risk for disorders of copper metabolism. Many studies on hemodialysis, peritoneal dialysis, and kidney transplant patients have focused on serum copper levels. Some reported mild deficiency, while others reported elevated levels or even toxicity. In some cases, it has been reported that alterations in copper metabolism lead to an increased risk of cardiovascular disease, malnutrition, anemia, or mielopathy. The aim of this review is to evaluate the role of copper in patients undergoing hemodialysis and its potential clinical implications.
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Affiliation(s)
- Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
| | - Luigi Peritore
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
| | - Vincenzo Labbozzetta
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
| | - Alfio Edoardo Giuffrida
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
| | - Antonella Lipari
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
| | - Eugenia Spallino
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
| | - Vincenzo Calabrese
- Unit of Nephrology and Dialysis, Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy;
| | - Luca Visconti
- Unit of Nephrology and Dialysis, Ospedali Riuniti Villa Sofia Cervello, University of Palermo, 90146 Palermo, Italy;
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.P.); (V.L.); (A.E.G.); (A.L.); (E.S.)
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Huang HX, Hobson K, Benedetti C, Kennedy S. Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d. Pediatr Nephrol 2024; 39:1405-1419. [PMID: 37698654 DOI: 10.1007/s00467-023-06132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
Children receiving maintenance dialysis (chronic kidney disease (CKD) stage 5d) have unique risk factors for micronutrient deficiency or toxicity. Children receiving chronic dialysis often require specialized diet plans that may provide more than the recommended daily allowance (RDA) of water-soluble vitamins and micronutrients, with or without the addition of a kidney-friendly vitamin. The following is a comprehensive review of current literature on disorders of micronutrients in this population including those of water-soluble vitamins (vitamin C and vitamin B complexes) and trace elements (copper, selenium, and zinc) and has three areas of focus: (1) the risk factors and clinical presentations of disorders of micronutrients, both deficiency and toxicity, (2) the tools to evaluate micronutrient status, and (3) the central role of renal dietitians in optimizing nutritional status from a micronutrient perspective.
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Affiliation(s)
| | - Kimberly Hobson
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, USA
| | | | - Sabina Kennedy
- Division of Nephrology, Emory University School of Medicine, 2015 Uppergate Drive, Office 316J, Atlanta, GA, 30322, USA.
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Azevedo R, Gennaro D, Duro M, Pinto E, Almeida A. Further Evidence on Trace Element Imbalances in Haemodialysis Patients-Paired Analysis of Blood and Serum Samples. Nutrients 2023; 15:nu15081912. [PMID: 37111132 PMCID: PMC10145991 DOI: 10.3390/nu15081912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Previous studies have shown that haemodialysis patients have an increased risk of trace element imbalances. Most studies have determined the concentration of trace elements in serum only, but most trace elements are not uniformly distributed between plasma and blood cells, which justifies separate analysis of the different compartments. In this study, we determined both the serum and whole blood concentration of a wide panel of trace elements (Li, B, Mn, Co, Ni, Cu, Zn, Se, Rb, Sr, Mo, Cd, Pb) in haemodialysis patients and compared them with those of a control group. Whole blood and serum samples were collected during routine laboratory testing of patients undergoing chronic haemodialysis. For comparison purposes, samples from individuals with normal renal function were also analysed. Statistically significant differences (p < 0.05) were found between the two groups for whole blood concentrations of all analysed elements except Zn (p = 0.347). For serum, the difference between groups was statistically significant for all elements (p < 0.05). This study confirms that patients on haemodialysis tend to present significant trace element imbalances. By determining the concentration of trace elements in both whole blood and serum, it was shown that chronic haemodialysis may affect intra- and extracellular blood compartments differently.
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Affiliation(s)
- Rui Azevedo
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Davide Gennaro
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padova, Italy
| | - Mary Duro
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- FP-ENAS-Fernando Pessoa Energy, Environment and Health Research Unit, Fernando Pessoa University, 4249-004 Porto, Portugal
- Laboratório de Análises Clínicas Dra. Matilde Sampaio, 5200-216 Mogadouro, Portugal
- Laboratório de Análises Clínicas Vale do Sousa, 4560-547 Penafiel, Portugal
| | - Edgar Pinto
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Environmental Health, ESS, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Agostinho Almeida
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
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Ume AC, Wenegieme TY, Adams DN, Adesina SE, Williams CR. Zinc Deficiency: A Potential Hidden Driver of the Detrimental Cycle of Chronic Kidney Disease and Hypertension. KIDNEY360 2023; 4:398-404. [PMID: 36996303 PMCID: PMC10103339 DOI: 10.34067/kid.0007812021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
Globally, over 103 million individuals are afflicted by CKD, a silent killer claiming the lives of 1.2 million people annually. CKD is characterized by five progressive stages, in which dialysis and kidney transplant are life-saving routes for patients with end stage kidney failure. While kidney damage impairs kidney function and derails BP regulation, uncontrolled hypertension accelerates the development and progression of CKD. Zinc (Zn) deficiency has emerged as a potential hidden driver within this detrimental cycle of CKD and hypertension. This review article will (1) highlight mechanisms of Zn procurement and trafficking, (2) provide evidence that urinary Zn wasting can fuel Zn deficiency in CKD, (3) discuss how Zn deficiency can accelerate the progression of hypertension and kidney damage in CKD, and (4) consider Zn supplementation as an exit strategy with the potential to rectify the course of hypertension and CKD progression.
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Affiliation(s)
- Adaku C. Ume
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, College of Science and Mathematics, Wright State University, Dayton, Ohio
| | - Tara-Yesomi Wenegieme
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, College of Science and Mathematics, Wright State University, Dayton, Ohio
| | - Danielle N. Adams
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, College of Science and Mathematics, Wright State University, Dayton, Ohio
| | - Sherry E. Adesina
- Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Clintoria R. Williams
- Department of Neuroscience, Cell Biology and Physiology, Boonshoft School of Medicine, College of Science and Mathematics, Wright State University, Dayton, Ohio
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Tuokkola J, Kiviharju E, Jahnukainen T, Hölttä T. Differences in Dietary Intake and Vitamin and Mineral Status of Infants and Children on Dialysis Receiving Feeds or Eating Normal Food. J Ren Nutr 2020; 31:144-154. [PMID: 32919822 DOI: 10.1053/j.jrn.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/10/2020] [Accepted: 07/16/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Knowledge of the vitamin and mineral intake and status of children on dialysis is scarce. Guidelines suggest supplementation of water-soluble vitamins, but the need for supplementation of minerals is less clear. We evaluated vitamin and mineral intake and status of children on chronic dialysis in our center. METHODS We reviewed patient records of all 33 children aged 0-16 years who were treated with chronic dialysis at a University Hospital between December 2014 and August 2019. Dietary intake was estimated from feed prescriptions and 3-day food records. Vitamin and mineral determinations were performed as part of routine care. RESULTS Food records or adherence to dietary prescription of feeds were available for 29 children. Dietary intake of most nutrients was sufficient in children on feeds, but children not on feeds had low intakes of vitamins D, B1, B2, and B6 as well as zinc, iron, and calcium from their diet. Insufficient intake was corrected with supplementation. We discovered some children with blood concentrations below the reference range for vitamins D (3.1%) and C (15.4%) and copper (16.7%) and selenium (3.1%). In contrast, various proportions of children with blood concentrations above the reference range were detected for all nutrients apart from vitamin D. CONCLUSIONS In our study, children receiving sufficient amounts of renal-specific feeds to meet at least 100% of age-specific requirements do not appear to need multivitamin-mineral supplementation, apart from vitamin D and calcium; in addition, children on PD usually need a sodium supplement and, on rare occasions with low intake from feeds, a phosphate supplement is needed. This study further revealed that other children at our center are more prone to deficient intakes of several vitamins and minerals, requiring supplementation based on dietetic review and, in some instances, laboratory measurements.
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Affiliation(s)
- Jetta Tuokkola
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Elina Kiviharju
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Jahnukainen
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Hölttä
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Joyce T, Rasmussen P, Melhem N, Clothier J, Booth C, Sinha MD. Vitamin and trace element concentrations in infants and children with chronic kidney disease. Pediatr Nephrol 2020; 35:1463-1470. [PMID: 32291535 PMCID: PMC7316696 DOI: 10.1007/s00467-020-04536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3-5 of chronic kidney disease (CKD). METHODS Retrospective cross-sectional review for nutritional blood concentrations measured over a recent 2-year period. In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B12 and folate are monitored annually. Vitamin D status is monitored every 6-12 months. RESULTS We reviewed 112 children (70 boys) with median (IQ1, IQ3) age 8.97 (4.24, 13.80) years. Estimated median (IQ1, IQ3) GFR (mL/min/1.73 m2) was 28 (21, 37). Vitamin A, active vitamin B12 and vitamin E concentrations were within normal range in 19%, 23% and 67% respectively, with all others being above normal range. Vitamin D blood concentrations were within desired range for 85% (15% had low levels) and folate blood concentrations were within normal range in 92%, with the remainder above or below target. For trace elements, 60%, 85% and 87% achieved normal ranges for zinc, selenium and copper respectively. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges. CONCLUSIONS Several vitamin and trace element blood concentrations were outside normal reference ranges. Monitoring vitamin D and zinc blood concentrations is indicated due to the percentages with low levels in this group. Targeted vitamin and trace element supplementation should be considered where indicated rather than commencing multivitamin and/or mineral supplementation. Graphical abstract Vitamin and trace element concentrations in infants and children with non-dialysis chronic kidney disease.
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Affiliation(s)
- Triona Joyce
- Department of Nutrition and Dietetics, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Pernille Rasmussen
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Joanna Clothier
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Caroline Booth
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, 3rd Floor Beckett House, Westminster Bridge Road, London, SE1 7EH, UK.
- Kings College London, London, UK.
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Escobedo-Monge MF, Ayala-Macedo G, Sakihara G, Peralta S, Almaraz-Gómez A, Barrado E, Marugán-Miguelsanz JM. Effects of Zinc Supplementation on Nutritional Status in Children with Chronic Kidney Disease: A Randomized Trial. Nutrients 2019; 11:nu11112671. [PMID: 31694220 PMCID: PMC6893698 DOI: 10.3390/nu11112671] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Zinc is an essential micronutrient for human beings and its deficiency affects their normal growth and development. OBJECTIVE The main aim was to evaluate the effect of two doses of zinc supplementation (ZS) on the nutritional status in chronic kidney disease (CKD) children. METHODS A randomized-trial multicentric study was conducted in 48 CKD (23 females) patients under 18-years-old, for a year. At random, participants took 30 or 15 mg/day of ZS, respectively. Anthropometric measurements and biochemical analysis were performed. Hypozincemia was determined by serum zinc concentration (SZC) using atomic absorption spectrophotometry. The positive or negative change in patients' body mass index (BMI) Z-score, serum albumin, zinc and C-reactive protein (CRP) levels were used to evaluate the effect of ZS. RESULTS Mean SZC was normal before and after ZS. Despite ZS, there were no significant changes in serum albumin, zinc and CRP levels. A positive and significant association was observed between SZC and serum albumin before (p = 0.000) and after (p = 0.007) ZS. In both groups of ZS, there was a small but positive and significant change in body mass and normalization in BMI Z-score, hypoalbuminemia, hypozincemia and high CRP, especially with 30 mg/day of ZS. CONCLUSIONS Zinc supplementation may be beneficial for nutritional status in children and adolescents with CKD.
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Affiliation(s)
- Marlene Fabiola Escobedo-Monge
- Faculty of Medicine, National University of San Marcos, Cangallo 818, 15001 Cercado de Lima, Peru
- National Institute of Child Health, Paediatric Nephrology Service, Avenida Brasil 600, 15083 Breña, Peru;
- Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain
- Correspondence: ; Tel.: +34-639-590-467
| | - Guido Ayala-Macedo
- Faculty of Medicine, National University of San Marcos, Cangallo 818, 15001 Cercado de Lima, Peru
| | - Graciela Sakihara
- National Institute of Child Health, Paediatric Nephrology Service, Avenida Brasil 600, 15083 Breña, Peru;
| | - Silvia Peralta
- Faculty of Food Science and Technology, National Agrarian University, Avenida la Molina, s/n, 15024 La Molina, Lima, Peru;
| | - Ana Almaraz-Gómez
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Valladolid University, 47005 Valladolid, Spain;
| | - Enrique Barrado
- Department of Analytical Chemistry, Science Faculty, University of Valladolid, Campus Miguel Delibes, Calle Paseo de Belén, 7, 47011 Valladolid, Spain;
| | - J. M. Marugán-Miguelsanz
- Department of Paediatrics of the Faculty of Medicine, Valladolid University, Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, 47005 Valladolid, Spain;
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Daenen K, Andries A, Mekahli D, Van Schepdael A, Jouret F, Bammens B. Oxidative stress in chronic kidney disease. Pediatr Nephrol 2019; 34:975-991. [PMID: 30105414 DOI: 10.1007/s00467-018-4005-4] [Citation(s) in RCA: 428] [Impact Index Per Article: 85.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/03/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
Abstract
Oxidative stress (OS), defined as disturbances in the pro-/antioxidant balance, is harmful to cells due to the excessive generation of highly reactive oxygen (ROS) and nitrogen (RNS) species. When the balance is not disturbed, OS has a role in physiological adaptations and signal transduction. However, an excessive amount of ROS and RNS results in the oxidation of biological molecules such as lipids, proteins, and DNA. Oxidative stress has been reported in kidney disease, due to both antioxidant depletions as well as increased ROS production. The kidney is a highly metabolic organ, rich in oxidation reactions in mitochondria, which makes it vulnerable to damage caused by OS, and several studies have shown that OS can accelerate kidney disease progression. Also, in patients at advanced stages of chronic kidney disease (CKD), increased OS is associated with complications such as hypertension, atherosclerosis, inflammation, and anemia. In this review, we aim to describe OS and its influence on CKD progression and its complications. We also discuss the potential role of various antioxidants and pharmacological agents, which may represent potential therapeutic targets to reduce OS in both pediatric and adult CKD patients.
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Affiliation(s)
- Kristien Daenen
- Department of Microbiology and Immunology, Laboratory of Nephrology, KU Leuven - University of Leuven, 3000, Leuven, Belgium.
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, 3000, Leuven, Belgium.
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Asmin Andries
- Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - Djalila Mekahli
- Department of Development and Regeneration, Laboratory of Pediatrics, PKD Group, KU Leuven - University of Leuven, 3000, Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Ann Van Schepdael
- Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - François Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Science, University of Liège, Liège, Belgium
| | - Bert Bammens
- Department of Microbiology and Immunology, Laboratory of Nephrology, KU Leuven - University of Leuven, 3000, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, 3000, Leuven, Belgium
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Kung WJ, Shih CT, Lee CH, Lin CC. The Divalent Elements Changes in Early Stages of Chronic Kidney Disease. Biol Trace Elem Res 2018; 185:30-35. [PMID: 29285723 DOI: 10.1007/s12011-017-1228-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/18/2017] [Indexed: 01/10/2023]
Abstract
As the glomerular filtration rate (GFR) decreases, it can cause imbalance in some divalent elements. These imbalances can cause increased oxidative stress in patients with renal impairment. The aim of present study was to investigate the changes of these divalent elements with CKD progression. One hundred and ninety-four patients with chronic kidney diseases (CKD) were divided into five stages, stage 1, 2, 3a, 3b, 4, and were recruited into this study. The divalent elements, calcium, magnesium, phosphorus, as well as iron, zinc, and copper were determined in clinical chemistry analyzer. Higher CKD stages were found to be associated with increased levels of phosphorus and copper; Ptrend values were 0.002 and 0.004, respectively. Also, higher CKD stages were associated with decreased levels of zinc; Ptrend value was 0.002, after adjustment for age, gender, smoke, education, diabetes, hypertension, and BMI. Decreased levels of zinc and elevated levels of phosphorus and copper might increase the oxidative stress and complications in CKD patients. Future randomized studies are needed to show whether adjusting dietary intake of phosphorus, copper, and zinc might affect the progression of CKD.
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Affiliation(s)
- Wan-Ju Kung
- Department of Laboratory Medicine, Fooyin University Hospital, Pingtung, Taiwan
| | - Ching-Tang Shih
- Department of Family Medicine, Fooyin University Hospital, Pingtung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health and Environmental Medicine Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chiang Lin
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung, Taiwan.
- Department of Education and Research, Fooyin University Hospital, Pingtung, Taiwan.
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Esmaeili M, Rakhshanizadeh F. Serum Trace Elements in Children with End-Stage Renal Disease. J Ren Nutr 2018; 29:48-54. [PMID: 30097325 DOI: 10.1053/j.jrn.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Trace elements, which have a crucial role in metabolism and enzymatic pathways, are not routinely monitored in the blood of pediatric patients with chronic kidney disease. The present study was carried out to determine the serum levels of copper (Cu), zinc (Zn), selenium (Se), and lead (Pb) in children with ESRD who were currently receiving conservative management or were on long-term hemodialysis or continuous ambulatory peritoneal dialysis. METHODS This study involved 200 children who met the inclusion criteria. The children were divided into 4 groups: a hemodialysis group, a peritoneal dialysis group, a group of children with ESRD treated with conservative management, and a control group. Serum levels of Zn, Cu, Se, and Pb were evaluated using an atomic absorption spectrophotometer and compared between the groups. RESULTS There was no significant difference in the serum concentration of Cu among the 4 study groups. There was also no significant difference in the serum concentrations of Zn, Se, and Pb between healthy children and children with CKD treated with conservative management or between the hemodialysis and peritoneal dialysis groups. The levels of Zn and Se were significantly lower in the hemodialysis and peritoneal dialysis groups than in the healthy children or in children with CKD treated with conservative management. The level of Pb in the blood was significantly lower in healthy children and children with CKD treated with conservative management than in the hemodialysis or peritoneal dialysis groups. CONCLUSIONS The levels of trace elements were substantially different between the dialysis groups and healthy children and children with CKD treated with conservative management. These results highlighted the role of osmosis during dialysis, as dialysate impurities can cause a disturbance in the levels of trace elements and the role of the kidney, even with minimum residual function, in the homeostasis of trace elements.
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Affiliation(s)
- Mohammad Esmaeili
- Associate Professor of Pediatric Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Forough Rakhshanizadeh
- Assistant Professor of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
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Serum copper levels are associated with bone mineral density and total fracture. J Orthop Translat 2018; 14:34-44. [PMID: 30035031 PMCID: PMC6034109 DOI: 10.1016/j.jot.2018.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/30/2022] Open
Abstract
Background Both copper deficiency and overexposure have been associated with adverse health effects. Evidence linking copper to bone mineral density (BMD) and total fracture, however, is limited. Methods This nationally representative cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey (2011–2014) in the United States. Using unadjusted and multivariate adjusted logistic regression analyses and a two-piecewise linear regression model with a smoothing function, we evaluated the associations between serum copper levels, bone mineral density and total fracture in 722 participants. Results The study sample (n = 722, mean age: 56.47 ± 11.55 y) represented a population of which 47.2% were men; 43.91% were non-Hispanic white, 18.84% non-Hispanic black and 13.71% Mexican American; 25.9% had total fracture. In the multivariate logistic regression analysis, individuals in the lowest category (<98.5 μg/dL) of serum copper concentration had 0.049 g/cm2 lower total femur BMD and 0.045 g/cm2 lower femoral neck BMD than those in the second concentration category (98.5–114 μg/dL). Individuals in the highest category (≥134 μg/dL) of serum copper concentration had an approximately 4-fold increase in the risk of total fracture than those in the second concentration category. There were no significant associations between per 10 μg/dL increases in serum copper levels and total fracture in multivariate logistic regression analysis after multivariate adjustment (all p > 0.05). However, a differential association between serum copper levels and total fractures between men and women was observed (odds ratio = 1.81, 95% confidence interval 1.08–3.03, p = 0.026 for men and odds ratio = 1.07, 95% confidence interval 0.86–1.32, p = 0.552 for women). Conclusion Moderate serum copper levels are critically important for bone health. Lower serum copper levels are significantly associated with decreased BMD in the total femur and femoral neck. Higher serum copper levels are significantly associated with increased total fracture, especially in men. The Translational Potential of this Article The impact of serum copper concentrations on bone mineral density and total fracture can provide insights into clinical application of copper-containing supplements and biomaterials.
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Key Words
- Bone mineral density
- Bone mineral density, BMD
- Centers for Disease Control and Prevention, CDC
- Confidence interval, CI
- Diastolic blood pressure, DBP
- Dual-energy x-ray absorptiometry, DXA
- Fracture
- High-density lipoprotein-cholesterol, HDL-C
- Low-density lipoprotein-cholesterol, LDL-C
- National Center for Health Statistics, NCHS
- National Health and Nutrition Examination Survey, NHANES
- Odds ratio
- Serum copper levels
- Standard deviation, SD
- Systolic blood pressure, SBP
- Total cholesterol, TC
- Triglycerides, TG
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Comparative Study on Trace Element Excretions between Nonanuric and Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. Nutrients 2016; 8:nu8120826. [PMID: 27999390 PMCID: PMC5188479 DOI: 10.3390/nu8120826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/26/2016] [Accepted: 12/15/2016] [Indexed: 01/08/2023] Open
Abstract
Few studies have been reported on alterations of trace elements (TE) in peritoneal dialysis patients. Our objective was to investigate and assess the characteristics of daily TE excretions in continuous ambulatory peritoneal dialysis (CAPD) patients. This cross-sectional study included 61 CAPD patients (nonanuric/anuric: 45/16) and 11 healthy subjects in Wuhan, China between 2013 and 2014. The dialysate and urine of patients and urine of healthy subjects were collected. The concentrations of copper (Cu), zinc (Zn), selenium (Se), molybdenum (Mo), and arsenic (As) in dialysate and urine were determined using inductively coupled plasma mass spectrometer (ICP-MS). Various clinical variables were obtained from automatic biochemical analyzer. Daily Cu, Zn, Se, and Mo excretions in nonanuric patients were higher than healthy subjects, while arsenic excretion in anuric patients was lower. A strong and positive correlation was observed between Se and Mo excretion in both dialysate (β = 0.869, p < 0.010) and urine (β = 0.968, p < 0.010). Furthermore, the clinical variables associated with Se excretion were found to be correlated with Mo excretion. Our findings indicated that nonanuric CAPD patients may suffer from deficiency of some essential TEs, while anuric patients are at risk of arsenic accumulation. A close association between Se and Mo excretion was also found.
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Li MS, Adesina SE, Ellis CL, Gooch JL, Hoover RS, Williams CR. NADPH oxidase-2 mediates zinc deficiency-induced oxidative stress and kidney damage. Am J Physiol Cell Physiol 2016; 312:C47-C55. [PMID: 27806940 DOI: 10.1152/ajpcell.00208.2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023]
Abstract
Zn2+ deficiency (ZnD) is comorbid with chronic kidney disease and worsens kidney complications. Oxidative stress is implicated in the detrimental effects of ZnD. However, the sources of oxidative stress continue to be identified. Since NADPH oxidases (Nox) are the primary enzymes that contribute to renal reactive oxygen species generation, this study's objective was to determine the role of these enzymes in ZnD-induced oxidative stress. We hypothesized that ZnD promotes NADPH oxidase upregulation, resulting in oxidative stress and kidney damage. To test this hypothesis, wild-type mice were pair-fed a ZnD or Zn2+-adequate diet. To further investigate the effects of Zn2+ bioavailability on NADPH oxidase regulation, mouse tubular epithelial cells were exposed to the Zn2+ chelator N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN) or vehicle followed by Zn2+ supplementation. We found that ZnD diet-fed mice develop microalbuminuria, electrolyte imbalance, and whole kidney hypertrophy. These markers of kidney damage are accompanied by elevated Nox2 expression and H2O2 levels. In mouse tubular epithelial cells, TPEN-induced ZnD stimulates H2O2 generation. In this in vitro model of ZnD, enhanced H2O2 generation is prevented by NADPH oxidase inhibition with diphenyleneiodonium. Specifically, TPEN promotes Nox2 expression and activation, which are reversed when intracellular Zn2+ levels are restored following Zn2+ supplementation. Finally, Nox2 knockdown by siRNA prevents TPEN-induced H2O2 generation and cellular hypertrophy in vitro. Together, these findings reveal that Nox2 is a Zn2+-regulated enzyme that mediates ZnD-induced oxidative stress and kidney hypertrophy. Understanding the specific mechanisms by which ZnD contributes to kidney damage may have an important impact on the treatment of chronic kidney disease.
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Affiliation(s)
- Mirandy S Li
- School of Medicine, Emory University, Atlanta, Georgia
| | - Sherry E Adesina
- School of Medicine, Emory University, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Carla L Ellis
- School of Medicine, Emory University, Atlanta, Georgia
| | - Jennifer L Gooch
- School of Medicine, Emory University, Atlanta, Georgia.,Pharmaceutical Sciences, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia; and.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Robert S Hoover
- School of Medicine, Emory University, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Clintoria R Williams
- School of Medicine, Emory University, Atlanta, Georgia; .,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
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14
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Filler G, Felder S. Trace elements in dialysis. Pediatr Nephrol 2014; 29:1329-35. [PMID: 23949629 DOI: 10.1007/s00467-013-2585-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 07/01/2013] [Accepted: 07/22/2013] [Indexed: 12/19/2022]
Abstract
In end-stage chronic kidney disease (CKD), pediatric nephrologists must consider the homeostasis of the multiple water-soluble ions that are influenced by renal replacement therapy (RRT). While certain ions such as potassium and calcium are closely monitored, little is known about the handling of trace elements in pediatric dialysis. RRT may lead to accumulation of toxic trace elements, either due to insufficient elimination or due to contamination, or to excessive removal of essential trace elements. However, trace elements are not routinely monitored in dialysis patients and no mechanism for these deficits or toxicities has been established. This review summarizes the handling of trace elements, with particular attention to pediatric data. The best data describe lead and indicate that there is a higher prevalence of elevated lead (Pb, atomic number 82) levels in children on RRT when compared to adults. Lead is particularly toxic in neurodevelopment and lead levels should therefore be monitored. Monitoring of zinc (Zn, atomic number 30) and selenium (Se, atomic number 34) may be indicated in the monitoring of all pediatric dialysis patients to reduce morbidity from deficiency. Prospective studies evaluating the impact of abnormal trace elements and the possible therapeutic value of intervention are required.
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Affiliation(s)
- Guido Filler
- Department of Paediatrics, Division of Nephrology, Children's Hospital, London Health Science Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, Canada, N6A 5W9,
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Argani H, Mahdavi R, Ghorbani-haghjo A, Razzaghi R, Nikniaz L, Gaemmaghami SJ. Effects of zinc supplementation on serum zinc and leptin levels, BMI, and body composition in hemodialysis patients. J Trace Elem Med Biol 2014; 28:35-8. [PMID: 24188897 DOI: 10.1016/j.jtemb.2013.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/28/2013] [Accepted: 09/02/2013] [Indexed: 11/20/2022]
Abstract
PROJECT The aim of this study was to determine the effects of zinc supplementation on serum zinc and leptin levels as well as on anthropometric status and some biochemical parameters in hemodialysis (HD) patients. PROCEDURE In this randomized, double-blind, and placebo-controlled trial, sixty HD patients were randomly divided into groups to receive a daily supplement of 100mg elemental Zn (supplemented group) or placebo (control group) for 60 days. Anthropometric measurements were taken using standard calibrated instruments. Serum zinc and leptin levels were determined by atomic absorption and ELISA method respectively before and after intervention. RESULTS Zinc supplementation resulted in significant increase in the mean serum zinc level in the experimental group while changes observed in the placebo group were not significant. The mean serum leptin in women part of the experimental group was decreased significantly after supplementation. After adjusting for age, BMI, body fat (%), serum zinc and dietary Zn intake, a negative and significant association was observed between serum zinc and leptin levels in all subjects (β=-0.33, P=0.03) as a result of Zn supplementation. CONCLUSIONS More studies are needed to clarify the mechanisms by which serum leptin level is influenced as a result of zinc supplementation in HD patients.
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Affiliation(s)
- Hassan Argani
- Shahid Beheshti Medical University, Department of Nephrology, Tehran, Iran.
| | - Reza Mahdavi
- Drug Applied Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Amir Ghorbani-haghjo
- Drug Applied Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Reza Razzaghi
- Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leila Nikniaz
- Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Seyed Jamal Gaemmaghami
- Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.
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16
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Zhang X, Liang D, Guo B, Deng W, Chi ZH, Cai Y, Wang L, Ma J. Zinc transporter 5 and zinc transporter 7 induced by high glucose protects peritoneal mesothelial cells from undergoing apoptosis. Cell Signal 2012; 25:999-1010. [PMID: 23275032 DOI: 10.1016/j.cellsig.2012.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 10/21/2012] [Accepted: 12/19/2012] [Indexed: 11/25/2022]
Abstract
Zinc is an essential micronutrient and cytoprotectant involved in many types of apoptosis. The zinc transporter family SLC30A (ZnTs) is an important factor in the regulation of zinc homeostasis; however, its function in apoptosis in peritoneal mesothelial cells (PMCs) remains unknown. This study explores the regulation of zinc transporters and how they play a role in cell survival, particularly in rat peritoneal mesothelial cells (RPMCs), surrounding glucose concentrations, and the molecular mechanism involved. The messenger RNA (mRNA) transcripts were quantitatively measured by real-time polymerase chain reaction for all known nine zinc transport exporters (SLC30A1-8,10), as well as in primary RPMCs and the cells cultured under nonstimulated and HG-stimulated conditions. While many zinc transporters were constitutively expressed, ZnT5 mRNA and ZnT7 mRNA were strongly induced by HG. Overexpression of ZnT5 and ZnT7 respectively resulted in a decrease in the expression of caspace 3, caspace 8, BAX, and AIF and coincided with cell survival in the presence of HG. Inhibition of ZnT5 and ZnT7 expression using considerable siRNA-mediated knockdown of RPMCs was examined and, afterwards, the impact on cell apoptosis was investigated. Increased levels of apoptosis were observed after knockdown of ZnT5 and ZnT7. Furthermore, overexpression of ZnT5 and ZnT7 is accompanied by activation of PI3K/Akt pathway and inhibiting HG-induced apoptosis. This study suggests that the zinc transporting system in RPMCs is influenced by exposure to HG, particularly ZnT5 and ZnT7. This may account for the inhibition of HG-induced RPMC apoptosis and peritoneum injury, likely through targeting PI3K/Akt pathway-mediated cell survival.
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Affiliation(s)
- Xiuli Zhang
- Department of Nephrology, the First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
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Lobo JC, Aranha LN, Moraes C, Brito LC, Mafra D. Linking zinc and leptin in chronic kidney disease: future directions. Biol Trace Elem Res 2012; 146:1-5. [PMID: 21947794 DOI: 10.1007/s12011-011-9211-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/12/2011] [Indexed: 02/05/2023]
Abstract
Anorexia is a common complication in patients with chronic kidney disease (CKD) and is associated with the development of malnutrition and an increased risk of mortality. Several compounds are linked to anorexia in these patients; however, the mechanisms are unknown. Zinc (Zn) deficiency is associated with decreased food intake and has been observed in CKD patients. In addition, leptin is an anorexigenic peptide, and patients with CKD present generally high levels of this hormone. Studies have suggested an association between Zn and leptin status in human and rats; however, the results are inconsistent. Some claimed that Zn supplementation does not change leptin release or that there is no significant relationship between Zn and leptin. Others have reported that Zn might be a mediator of leptin production. CKD patients have hyperleptinemia and hypozincemia, but the relationship between Zn deficiency and leptin levels in CKD patients has been poorly understood until now. The aim of this review is to integrate knowledge on leptin and Zn actions to provide a cohesive clinical perspective regarding their interactions in CKD patients.
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Affiliation(s)
- Julie Calixto Lobo
- Federal University of Rio de Janeiro, Institute of Biophysic Carlos Chagas Filho, Health Science Centre, Rio de Janeiro, Brazil
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18
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Effects of hemodialysis period on levels of blood trace elements and oxidative stress. Clin Exp Nephrol 2010; 14:463-8. [DOI: 10.1007/s10157-010-0310-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
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Lobo JC, Torres JPM, Fouque D, Mafra D. Zinc deficiency in chronic kidney disease: is there a relationship with adipose tissue and atherosclerosis? Biol Trace Elem Res 2010; 135:16-21. [PMID: 19760368 DOI: 10.1007/s12011-009-8504-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022]
Abstract
Cardiovascular complications caused by an accelerated atherosclerotic disease consist the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). These patients present multiple atherosclerotic risk factors, considered traditional, as well as nontraditional risk factors such as inflammation and oxidative stress. These complications are also seen in obesity, in which endothelial dysfunction is one of the early stages of atherosclerosis. The impact of trace metal deficiencies on this process is not well studied in patients with CKD and in obese people, although the influence of trace elements depletion, particularly zinc (Zn), may have significant clinical implications. This brief review describes the functions of Zn as well as the respective role of this trace element in atherosclerosis processes, with a particular emphasis on obese patients with chronic kidney disease.
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Affiliation(s)
- Julie Calixto Lobo
- Federal University of Rio de Janeiro, Institute of Biophysics Carlos Chagas Filho, Health Science Centre, Rio de Janeiro, Brazil
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El Tayeb AA, Abd El-Mottaleb NA, Abdel Aziz EA. Relationship between serum parathyroid hormone and trace elements (serum zinc and magnesium) in hemodialyzed chronic renal failure children. Biol Trace Elem Res 2009; 128:128-34. [PMID: 18972069 DOI: 10.1007/s12011-008-8265-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 10/16/2008] [Indexed: 11/29/2022]
Abstract
Secondary hyperparathyroidism and trace elements' metabolism disturbances are common, important, and treatable complications of chronic renal failure (CRF).The relation between parathyroid hormone (PTH) and some trace elements in CRF patients on hemodialysis is still not completely elucidated. The aim of this work is to determine the serum levels of PTH and the trace elements zinc (Zn) and magnesium (Mg) in children with CRF under hemodialysis. The relation between PTH and those trace elements will be investigated. The study included 24 children (15 males and nine females) with CRF on regular hemodialysis. Also, 15 healthy age-matched children were included as control group. Serum levels of PTH, zinc, and magnesium were determined in all cases and controls. PTH and magnesium levels in patients were significantly higher than controls. Serum zinc levels were significantly lower than controls. There was a significant negative correlation between serum levels of PTH and zinc as well as an insignificant negative correlation between PTH and serum magnesium in CRF patients. Elevated PTH may play a role in the pathogenesis of hypozincemia. However, this is another negative report on the relation between PTH and serum Mg in children with CRF.
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Affiliation(s)
- Azza A El Tayeb
- Department of Pediatric, Faculty of Medicine, Asyut University, Asyut, Egypt
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Btaiche IF. Serum trace element concentrations in children with chronic renal failure. Pediatr Nephrol 2007; 22:618-9. [PMID: 17131160 PMCID: PMC1805048 DOI: 10.1007/s00467-006-0386-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 10/18/2006] [Indexed: 11/29/2022]
Affiliation(s)
- Imad F. Btaiche
- Department of Pharmacy Services, University of Michigan Hospitals and Health Centers, UH B2 D301 - Box 0008, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0008 USA
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