Variation of trace element concentrations in patients undergoing hemodialysis in the north of Spain

Trace Elements Status and Their Associations With Related Antioxidant Enzyme Activities in Patients Receiving Peritoneal Dialysis and Hemodialysis

OBJECTIVE

It remains ambiguous as to whether the status of trace elements would affect their related enzyme activities toward defending a possible higher oxidative stress in patients receiving peritoneal dialysis (PD) or hemodialysis (HD) treatment. We investigated copper (Cu), zinc (Zn), and selenium (Se) status in patients receiving PD or HD treatments and further determined the association of these trace elements with their related antioxidant capacities in those patients.

METHODS

Sixty PD and 80 HD patients before and after HD treatment had their blood drawn. Demographic, clinical, and 24-hour diet recall data were recorded and collected. Plasma trace elements, oxidative stress indicators, and antioxidant enzyme activities were measured.

RESULTS

Patients receiving PD or HD treatments experienced similar Zn and Cu intakes. PD and HD patients displayed adequate mean plasma Cu, Zn, and Se levels. Patients receiving PD treatment showed significantly higher levels of Cu, Zn, advanced oxidation protein products (AOPPs), and superoxide dismutase (SOD) activity, but had significantly lower levels of Se and total antioxidant capacity when compared to levels in the HD patients at the pre-HD session. The levels of 3 trace elements and AOPP increased significantly, while the levels of glutathione (GSH), oxidized glutathione (GSSG), GPx, and SOD activities decreased significantly after receiving HD treatment than did the levels in the pre-HD session. Plasma Cu, Se, and Zn levels had a different correlation with plasma AOPP level, GPx, and SOD activities during PD, pre- or post-HD sessions. Plasma Cu, Zn, and Se levels did not have any association with their associated enzyme activities in patients with PD, while plasma Cu and Zn levels may have influenced SOD activity in HD patients.

CONCLUSIONS

An adequate Cu, Zn, and Se status is required in order to help their associated enzyme activity cope with increased oxidative stress during PD or HD sessions.

The arsenic-lowering effect of inulin-type prebiotics in end-stage renal disease: a randomized crossover trial

Background: Circulatory imbalance of trace elements is frequent in end-stage renal disease (ESRD), leading to a deficiency of essential elements and excess of toxic elements. The present study aimed to investigate whether inulin-type fructans (ITFs) could ameliorate the circulatory imbalance by modulating gut microbiota and regulating the absorption and elimination of trace elements. Methods: Peritoneal dialysis patients were enrolled in a randomized crossover trial, undergoing interventions with ITFs (10 g d-1) and maltodextrin (placebo) over a 9-month period (with a 3-month washout). The primary outcomes included essential elements Mn, Fe, Co, Cu, Zn, Se, Sr, and Mo and potential toxic elements V, Cr, Ni, As, Cd, Ba, Tl, Pb, Th, and U in plasma. Secondary outcomes included the gut microbiome, short chain fatty acids (SCFAs), bile acids (BAs), and daily removal of trace elements through urine, dialysate and feces. Results: Among the 44 participants initially randomized, 29 completed the prebiotic, placebo or both interventions. The daily dietary intake of macronutrients and trace elements remained consistent throughout the study. The administration of 10 g d-1 ITFs significantly reduced plasma arsenic (As) by 1.03 μg L-1 (95%CI: -1.74, -0.33) (FDR-adjusted P = 0.045) down from the baseline of 3.54 μg L-1 (IQRs: 2.61-4.40) and increased the As clearance rate by urine and dialysis (P = 0.033). Positive changes in gut microbiota were also observed, including an increase in the Firmicutes/Bacteroidetes ratio (P = 0.050), a trend towards higher fecal SCFAs (P = 0.082), and elevated excretion of primary BAs (P = 0.035). However, there were no significant changes in plasma concentrations of other trace elements or their daily removal by urine, dialysis and feces. Conclusions: The daily administration of 10 g d-1 ITFs proved to be effective in reducing the circulating retention of As but demonstrated to be ineffective for other trace elements in ESRD. These sentences are ok to include but as "The clinical trial registry number is ChiCTR-INR-17013739 (https://www.chictr.org.cn/showproj.aspx?proj=21228)".

Further Evidence on Trace Element Imbalances in Haemodialysis Patients-Paired Analysis of Blood and Serum Samples

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.

Haemodialysis alters the serum metal contents in chronic kidney failure patients at hyderabad and adjoining areas

Present study aimed to explore alterations of serum metal contents in patients of chronic kidney disease before and after haemodialysis (HD) compared to controls. For the levels of heavy metals in serum samples of kidney patients before and after HD belonging to different areas of Hyderabad and adjoining areas admitted at different hospitals of Hyderabad. In this study, the level of copper (Cu), zinc (Zn), chromium (Cr), iron (Fe) and manganese (Mn) in serum sample of kidney patients and controls have been investigated using Atomic Absorption Spectrophotometer (AAS). An increase in serum urea and serum creatinine levels in patients with chronic kidney disease (CKD) when compared to controls was observed and it was due to the decreased glomerular filtration in patients with CKD. The average of serum Cu and Cr were significantly high in pre-HD patients as compared to controls, reverse was found just in case of Mn and Fe. Serum Cu and Mn were significantly increased in post-HD patients when put next to the controls, whereas, serum Cr concentration was significantly decreased after HD in comparison to the controls. Concentration of serum Cu, Fe and Mn were significantly increased in post-HD patients as compared to the pre-HD patients. In conclusion, hemodialysis alters the serum metal contents in CKD patients. After the study, it is suggested that, serum metal contents before the dialysis session must be investigated more extensively to elucidate the alterations throughout the dialysis session and may be medicated accordingly.

In end-stage kidney disease, inflammation, erythron abnormalities and declined kidney function tests are accompanied by increased affective symptoms, chronic-fatigue, and fibromyalgia.. [DOI: 10.1101/2023.01.12.23284460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background

Numerous neuropsychiatric symptoms, including affective symptoms, chronic fatigue syndrome, and fibromyalgia symptoms, are present in patients with end-stage renal disease (ESRD). This study examines the relationship between neuropsychiatric symptoms and red blood cell (RBC) parameters, kidney function tests, zinc, C-reactive protein, and calcium levels in patients with ESRD.

Methods

The above biomarkers and the Beck-Depression Inventory, the Hamilton Anxiety Rating Scale, and the Fibro-Fatigue Rating Scale were measured in 70 patients with end-stage renal disease (ESRD) and 46 healthy controls.

Results

Increased scores of depressive, anxious, cognitive, and physiosomatic symptoms (including chronic fatigue, fibromyalgia, and autonomous symptoms) characterise ESRD. One latent vector could be extracted from these diverse symptom domains, which are, therefore, manifestations of a common core referred to as the physio-affective phenome. The combined effects of aberrations in red blood cells (RBC) (number of RBC, hematocrit, and haemoglobin), kidney function tests (glomerular filtration rate, ureum, creatinine, albumin, and total serum protein), C-reactive protein, zinc, and copper explained 85.0% of the variance in the physio-affective phenome. In addition, the effects of kidney function decline on the phenome were partially mediated by RBC aberrations and elevated copper, whereas the effects of dialysis frequency were entirely mediated by decreased zinc and elevated CRP.

Conclusions

Affective (depression and anxiety), cognitive, and physiosomatic symptoms due to ESRD are interrelated manifestations of the physio-affective phenome, which is driven by (in descending order of importance) kidney dysfunctions, erythron deficits, inflammation, elevated copper, and decreased zinc.

Serum Zinc Levels in Chronic Kidney Disease Patients, Hemodialysis Patients, and Healthy Controls: Systematic Review and Meta-Analysis

OBJECTIVES

Patients with chronic kidney disease (CKD) are susceptible to changes in zinc homeostasis through anorexia and dietary restrictions, as well as hemodialysis (HD). Changes in zinc homeostasis might predispose CKD and HD patients to specific adverse effects, including erythropoietin-resistant anemia, oxidative stress, atherosclerosis, and cardiovascular disease. Because serum zinc levels are rarely measured in CKD and HD patients, zinc supplementations do not represent a routine therapy for CKD and dialysis patients. Therefore, in this meta-analysis, we aimed to assess serum zinc levels in CKD and HD patients compared with healthy controls (HC). In addition, we investigated whether HD affects serum zinc levels by comparing serum zinc levels in HD versus CKD patients and comparing serum zinc pre- versus post-HD.

DESIGN AND METHODS

A comprehensive search of databases was conducted to identify either observational studies or randomized trials that assessed serum zinc levels in either CKD and/or HD patients in comparison to HC. We conducted a random-effects meta-analysis.

RESULTS

Our meta-analysis included 42 studies with a total of 4,161 participants, of whom 460 were CKD patients, 2,047 were HD patients, and 1,654 were HCs. Both CKD and HD patients showed lower serum zinc levels compared with HC (mean difference = -22.86 μg/dL, 95% CI -33.25 to -12.46; mean difference = -13.64 μg/dL, 95% CI -21.47 to -53.80, respectively). CKD and HD patients showed no significant difference in serum zinc levels (mean difference = 15.39, 95% CI -8.91 to 39.68). Pre-HD serum zinc levels were significantly lower than those post-HD (mean difference = -7.51 μg/dL, 95% CI -14.24 to -0.78).

CONCLUSION

In the current study, the serum zinc levels were lower in CKD and HD patients compared to HCs and appears to be more common than reported in daily clinical practice. It may be beneficial to assess serum zinc levels in CKD and HD patients. More research on zinc in kidney disease is encouraged.

Circulatory Imbalance of Essential and Toxic Trace Elements in Pre-dialysis and Hemodialysis Patients

The status of essential and toxic trace elements in patients with different stages of chronic kidney disease (CKD) is still unclear and not well characterized. The present study examined the circulatory levels of a wide panel of trace elements (Al, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Sr, Cd, Pb, and U) in hemodialysis patients (HD group) and pre-dialysis patients with stage 3 CKD (PD group). Comparisons were made between groups of patients and healthy individuals from the control group (CG). The levels of Al, Mn, Co, Ni, Cu, As, Se, Sr, and Pb were higher, while the levels of Cr, Zn, Rb, Cd, and U were lower in HD patients than in our CG. Higher levels of Al and Se, as well as lower levels of As, Sr, Zn, Rb, and U were significant and distinguished HD from PD. Among other analyzed elements, Co, Se, and U are the only trace elements that did not distinguish PD from CG at a statistically significant level. The HD group had lower serum U levels than the PD group, and this could be a result of hemodialysis. This study also revealed that the Cu/Zn ratio could be used as a marker for early and late detection of renal failure. Marked changes of essential and toxic trace element levels in sera indicate additional pathophysiological events in CKD, which could additionally contribute to the preexisting increased morbidity of HD patients. Measurement of trace elements in HD patients should be performed routinely.

Hemodialysis Effect on the Composition of the Eye Fluid of Cataract Patients

Numerous reports have proven that dialysis patients experience disturbances in the levels of elements in biological fluids. Disturbances in the homeostasis of essential elements or the appearance of highly toxic elements are serious problems also in clinical ophthalmology. The purpose of this study was to investigate the influence of hemodialysis (HD) on the elemental composition of anterior chamber aqueous humor (AH) in patients undergoing cataract surgery. The study involved 22 patients. The control group enrolled 16 patients (age 75.68 ± 9.67, female 54.55%, male 45.45%) with cataract and normal kidney function (control), and the second group included six patients (age 70.33 ± 12.74, female 33.33%, male 66.67%) with cataract undergoing HD treatment. The elements quantification was established using an inductively coupled plasma optical emission spectrometer (ICP-MS). In the eye fluid of dialysis patients, there were increased levels of manganese (Mn) and mercury (Hg) and decreased levels of vanadium (V) and zinc (Zn). In addition, a statistically significant increase in the Hg/Zn and Hg/selenium (Se) ratios and a lowering of the iron (Fe)/Mn ratio were observed in the studied group in comparison to the control. The obtained results indicated the need for Zn and Se supplementation in order to eliminate the hazards caused by Hg toxicity. A lower level of V in the eye fluid of dialysis patients may have a positive effect on maintaining a calcium and phosphorus homeostasis. Our study gives a deep insight into changes of elements concentrations in AH induced by HD.

Wnt/β-catenin pathway proteins in end-stage renal disease

Aim: To delineate the association of end-stage renal disease (ESRD) and Wnt-proteins including the agonist R-spondin-1, the transducer β-catenin and the antagonists DKK1 and sclerostin. Materials & methods: Serum Wnt-pathway proteins levels were measured by ELISA in 60 ESRD patients and 30 normal controls. Results: DKK1 and sclerostin were significantly higher in ESRD than in controls, and β-catenin and the catenin + R-spondin-1/DKK1 + sclerostin ratio, reflecting the ratio of agonist and transducer on antagonists (AT/ANTA), were significantly lower in ESRD. Estimated glomerular filtration rate was significantly associated with DKK1 and sclerostin (inversely), β-catenin (positively) and the AT/ANTA ratio (r = 0.468, p < 0.001). Conclusion: Wnt/β-catenin pathway proteins show significant alterations in ESRD, indicating significantly increased levels of antagonists.

Selenium Nutritional Status and Glutathione Peroxidase Activity and Its Relationship with Hemodialysis Time in Individuals Living in a Brazilian Region with Selenium-Rich Soil

Suboptimal selenium status may impair the antioxidant defense system in patients undergoing hemodialysis, compromising the selenoenzyme glutathione peroxidase activity. To evaluate the association between the duration of hemodialysis, nutritional selenium status, glutathione peroxidase activity (GPx), and thiobarbituric acid reactive substance (TBARS) levels in patients with chronic renal failure undergoing hemodialysis in a region of selenium-rich soils (Ceará, Northeast Brazil). The case-control study of 75 individuals aged 18 to 88 years was allocated between two groups: hemodialysis (n = 41) and control (n = 34). Plasma and erythrocytes selenium levels were determined by inductively coupled plasma optical emission spectrometry. The GPx activity and TBARS levels were also evaluated. In addition, the hemodialysis group was stratified according to the duration of treatment (≤ 59 months and ≥ 60 months). The Mann-Whitney test, Student's t test, and Pearson's or Spearman's correlation were applied according to the data distribution. Moreover, a quantile regression was performed. The significance level (p) was < 0.05. The hemodialysis group had lower selenium levels in their plasma and erythrocytes than the control group (p < 0.001). However, there was no difference in the GPx activity between the groups. Furthermore, an association between the hemodialysis group and selenium levels in plasma (coefficient - 16,343, p < 0.001) and erythrocytes (coefficient - 7839, p = 0.003) was observed by quantile regression, independent of age, sex, and body-mass index. In individuals who had undergone treatment for 60 months or more, GPx activity was lower (p = 0.026) and TBARS levels higher (p = 0.011) than in those who had undergone treatment for less than 60 months. The status of selenium was reduced in the hemodialysis group compared to the control group. The lower GPx activity and higher levels of TBARS in individuals who had undergone treatment for 60 months or more correlated with greater oxidative stress.

Associations Between Blood Trace Element Levels and Nutritional Status in Maintenance Hemodialysis

OBJECTIVE(S)

We aimed to investigate the associations between blood trace element levels and nutritional status in patients undergoing maintenance hemodialysis (MHD).

METHODS

This cross-sectional study included patients undergoing MHD who were treated at our center in September 2019. Clinical and demographic data and blood samples were collected before hemodialysis sessions, and the levels of manganese, lead, selenium, zinc, and copper were measured by inductively coupled plasma mass spectrometry. The Simplified Nutritional Appetite Questionnaire scale was used to assess patient appetite. Skinfold thickness, bicep circumference, upper arm muscle circumference, 7-point Subjective Global Assessment, Nutritional Risk Screening 2002 (NRS 2002), and Geriatric Nutritional Risk Index (GNRI) were used to assess patient nutritional status. Univariate and multivariate logistic regression analyses were performed to study the relationship between trace elements and nutritional indicators.

RESULTS

In total, 118 patients (64 males and 54 females) were included, with a median dialysis vintage of 34.0 months (16.0-54.5 months) and an average age of 63.20 ± 14.26 years. Malnourished patients, as defined by the GNRI, Subjective Global Assessment, and NRS 2002, accounted for 28.0%, 49.2%, and 26.3% of enrolled patients, respectively. The multivariate binary logistic regression showed that higher blood copper levels were independently associated with nutritional risk defined as GNRI ≤91.2 (odds ratio [OR] = 1.003, 95% confidence interval [CI] = 1.000-1.006; P = .020), whereas lower blood zinc levels (OR = 0.634, 95% CI = 0.439-0.916; P = .015), blood zinc < 4.220 mg/L (OR = 3.723, 95% CI = 1.274-10.879; P = .016), lower blood selenium levels (OR = 0.959, 95% CI = 0.929-0.990; P = .010), and blood selenium < 85 μg/L (OR = 5.568, 95% CI = 1.039-29.840; P = .045) were independently associated with a nutritional risk defined as NRS 2002 ≥ 3.

CONCLUSION(S)

Higher levels of blood copper and lower levels of blood zinc and selenium were independently associated with higher nutritional risk in MHD patients.

Integration of biomonitoring data and reverse dosimetry modeling to assess population risks of arsenic-induced chronic kidney disease and urinary cancer

Chronic exposure to inorganic arsenic (iAs) is associated with chronic kidney disease (CKD) and urinary cancer, but the risks are poorly understood. Human biomonitoring can serve as a tool to better quantify human exposure and to conduct risk assessment. We aimed to assess the population risks of CKD and urinary cancer due to iAs intake based on the blood arsenic concentrations of 601 participants in Taiwan. A physiologically based pharmacokinetic modeling-based reverse dosimetry was conducted to estimate the daily intakes of iAs (DI_iAs). We performed the benchmark dose (BMD) modeling for CKD using participants' estimated glomerular filtration rate (eGFR) and the estimated DIiAs to derive a point of departure (POD). Margin of exposure (MOE) was used to characterize the risks. The population with eGFR values of <60 mL/min/1.73 m² had significantly higher DI_iAs (median: 3.20 μg/kg/day, 2.5th-97.5th percentiles: 2.35-4.67 μg/kg/day) than those with normal renal function (1.99, 1.22-3.42 μg/kg/day). The POD for CKD was 1.557 μg/kg/day, which could serve as a possible reference value for CKD risk assessment. The MOEs indicated that the CKD risk due to iAs intake may potentially be a cause for high concern for the population with reduced renal function. The iAs-induced urinary cancer risk may be a cause for moderate-to-high concern.

Trace element imbalances in patients undergoing chronic hemodialysis therapy - Report of an observational study in a cohort of Portuguese patients

INTRODUCTION

Patients with end-stage renal disease undergoing hemodialysis therapy are at risk of developing deficiencies of essential trace elements and/or overload of toxic trace elements, both of which may significantly affect their clinical status of. Those imbalances may result from the disease itself but also from the quality of the therapeutic process, namely the hemodialysis process, which has greatly evolved in the last decades. Thus, old observations that have been assumed as very well-proven have been recently questioned. In this case-control study we evaluate the current trace elements status in a group of Portuguese patients under hemodialysis therapy.

MATERIAL AND METHODS

Serum samples from patients (n = 93), collected for the routine periodic control of Al levels, were analyzed for a wide panel of trace elements (Li, Al, Mn, Co, Ni, Cu, Zn, Se, Rb, Sr, Mo, Cd, Ba, Pb) using inductively coupled plasma mass spectrometry technique (hemodialysis patients' group). For comparison purposes, samples of individuals with no evidence of renal disease according to standard laboratory analytical criteria (n = 50) were also analyzed (control group).

RESULTS

The results showed significant differences between the two groups, with higher values in hemodialysis patients group for Al (14.6 vs. 9.5 μg/L), Co, Ni, Sr, Mo (4.5 vs. 1.4 μg/L), Cd (0.058 vs. 0.025 μg/L) and Pb (0.55 vs. 0.30 μg/L); and lower values in hemodialysis patients group for Li (4.0 vs. 75.8 μg/L), Mn, Cu (943.5 vs. 1038.5 μg/L), Zn (943.5 vs. 1038.5 μg/L), Se (71.5 vs. 103.8 μg/L), Rb (202.4 vs. 300.3 μg/L) and Ba (0.65 vs. 8.7 μg/L).

CONCLUSION

This study confirms that hemodialysis patients tend to present significant trace elements imbalances, which may be related to the higher morbidity and mortality observed in this specific patients' group.

A Clinical Tool to Predict Low Serum Selenium in Patients with Worsening Heart Failure

Selenium is an essential micronutrient, and a low selenium concentration (<100 µg/L) is associated with a poorer quality of life and exercise capacity, and an impaired prognosis in patients with worsening heart failure. Measuring selenium concentrations routinely is laborious and costly, and although its clinical utility is yet to be proven, an easy implemented model to predict selenium status is desirable. A stepwise multivariable logistic regression analysis was performed using routinely measured clinical factors. Low selenium was independently predicted by: older age, lower serum albumin, higher N-terminal pro-B-type natriuretic peptide levels, worse kidney function, and the presence of orthopnea and iron deficiency. A 10-points risk-model was developed, and a score of ≥6 points identified >80% of patients with low selenium (sensitivity of 44%, specificity of 80%). Given that selenium and iron overlap in their physiological roles, we evaluated the shared determinants and prognostic associates. Both deficiencies shared similar clinical characteristics, including the model risk factors and, in addition, a low protein intake and high levels of C-reactive protein. Low selenium was associated with a similar or worse prognosis compared to iron deficiency. In conclusion, although it is difficult to exclude low selenium based on clinical characteristics alone, we provide a prediction tool which identifies heart failure patients at higher risk of having a low selenium status.

Zinc Deficiency in Men Over 50 and Its Implications in Prostate Disorders

Research has been consistently showing the role of zinc (Zn) in prostate function. In this article, we review the current literature on the anatomy and main functions of the prostate, highlighting the role of zinc. In particular, we will review the etiology of benign prostate enlargement (BPH), its prevalence in men over 50, the likelihood of BPH becoming prostate cancer (PCa), and explain the relationship of zinc and apoptosis in the prostate cells and the implications for BPH and PCa. We present a model that explains how endogenous factors provoke excretion of zinc or limit zinc absorption, and how exogenous factors like nutrition and drugs regularly used in men over 50 can significantly decrease zinc status and thereby increase the risk of BPH. Finally, we explain how Zn amino acid (AA) complexes may be capable of avoiding antagonists and inhibitors of zinc absorption, thereby increasing the bioavailability of zinc for the necessary biological processes in the prostate.

da Veiga G, da C.A. Alves B, Murad N, Fonseca FL. The Impact of Inflammatory Profile on Selenium Levels in Hemodialysis Patients

Introduction: Hemodialysis stands out as an eligible treatment for patients with chronic kidney disease. The subsequent inflammatory process resulting from this disease and hemodialysis per se is exacerbated in this therapy. Selenium (Se) is an essential trace element that can participate in the inhibition of pro-oxidant and pro-inflammatory processes and could be considered a measurement that indicates the progression of chronic kidney disease and inflammation.

Objectives: The present study investigated selenemia in hemodialysis patients of the ABC region of São Paulo and aimed to establish the correlation between an inflammatory marker and selenemia in this conditions disease.

Methods: This is an observational cross-sectional study of the Faculdade de Medicina do ABC in patients submitted to hemodialysis three times a week for at least six months. The eligible group composed of 21 patients, who filled out forms and underwent biochemical tests (colorimetric enzyme methods, flow cytometer, turbidimetric method and mass spectrometry).

Results: The study population showed, women (70%), men (30%) with a mean age of 47 ± 17 years, Caucasians (36%) and non-Caucasian (64%), hypertensive (68%), smokers (53%) and non-smokers (64%). There was a hegemonic prevalence of systolic arterial hypertension (SAH) 68.1% in relation to diabetes mellitus (DM) (50%). Pre and post hemodialysis (HD) selenemia showed statistical significance, which did not occur with C-reactive protein. There was a predominance of females in our sample; the pre- and post-HD selenemia were within the normal range of the reference values; there was a statistically significant correlation between pre and post-HD selenemia; there was no correlation with statistical significance between values of pre and post-HD C-reactive protein.

Conclusion: Our data showed that there was no direct relationship between pre- and post-HD inflammation and pre- and post-HD selenemia.

Simultaneous multielement analysis by ICP-MS with simple whole blood sample dilution and its application to uremic patients undergoing long-term hemodialysis

Few studies were reported on trace elements' alterations in uremic patients undergoing long-term (>24 months) hemodialysis (HD), especially by using the whole blood as the biological fluid for the measuring purpose. Our objective was to develop an improved micro-sampling inductively coupled plasma-mass spectrometry (ICP-MS) method to determine the levels of Ca, Mg, Cu, Zn, Fe, Mn, Se and Pb in uremic patients receiving long-term HD. A ICP-MS method with a modified whole blood sample preparation procedure with small volumes was established and applied for the simultaneous quantification of the various elements in uremic patients undergoing long-term HD. 124 eligible uremic patients receiving long-term HD (75 males and 49 females) and 77 healthy subjects (54 males and 23 females) were recruited and Ca, Mg, Cu, Zn, Fe, Mn, Se and Pb levels were further determined. Our results revealed that uremic patients with HD had significantly higher blood levels of Ca, Mg, Zn and Pb and lower Cu, Fe, Se and Mn concentrations than healthy controls. In conclusion, a reproducible and reliable ICP-MS method using minimal whole blood sample volume (50 μL) with a simple dilution-based preparation procedure was successfully improved, validated and applied. Uremic patients undergoing long-term HD might be at increased risk of some essential trace elements deficiency (especially for Cu, Fe and Se) or toxic trace element excess (Pb) in respect to healthy subjects. Monitoring of blood levels and supplementation of some trace elements may be indicated in uremic patients undergoing long-term HD.

High serum arsenic and cardiovascular risk factors in patients undergoing continuous ambulatory peritoneal dialysis

The present study aims to assess arsenic accumulation and explore its association with renal function and biomarkers of CVD risk in chronic kidney disease patients receiving continuous ambulatory peritoneal dialysis (CAPD). The serum was collected from 87 CAPD patients and 26 healthy subjects between 2015 and 2016. The arsenic concentration was measured by inductively coupled plasma mass spectrometer. Clinical variables related to CVD risk were determined with automatic biochemical analyzer. Serum arsenic was higher in CAPD patients as compared to healthy volunteers. Moreover, significant differences of BMI, serum phosphorus, eGFR and Ccr were observed among groups. Positive correlation between serum arsenic and serum phosphorus was found (r = 0.453, p < 0.001). While serum arsenic was negatively associated with Ccr (r = -0.328, p = 0.002) and eGFR (r = -0.248, p  = 0.020). The logistic regression models revealed that high serum arsenic was related to hyperphosphatemia (ORs, 1.827; 95%CI, 1.145-2.913) after adjusted for the potential confounding factors. Overall, our findings inferred the accumulation of arsenic in CAPD patients. In addition, high serum arsenic was independently associated with the occurrence of hyperphosphatemia, which was a special and ubiquitous CVD risk factor in CAPD patients. This study provided a clue for the association between arsenic and CVD burden in CKD patients. At the same time, it suggested that prevention of arsenic accumulation should be taken into consideration clinically.

Zinc Inhibits Phosphate-Induced Vascular Calcification through TNFAIP3-Mediated Suppression of NF-κB

Background The high cardiovascular morbidity and mortality of patients with CKD may result in large part from medial vascular calcification, a process promoted by hyperphosphatemia and involving osteo-/chondrogenic transdifferentiation of vascular smooth muscle cells (VSMCs). Reduced serum zinc levels have frequently been observed in patients with CKD, but the functional relevance of this remains unclear.Methods We performed experiments in primary human aortic VSMCs; klotho-hypomorphic (kl/kl), subtotal nephrectomy, and cholecalciferol-overload mouse calcification models; and serum samples from patients with CKD.Results In cultured VSMCs, treatment with zinc sulfate (ZnSO₄) blunted phosphate-induced calcification, osteo-/chondrogenic signaling, and NF-κB activation. ZnSO₄ increased the abundance of zinc-finger protein TNF-α-induced protein 3 (TNFAIP3, also known as A20), a suppressor of the NF-κB pathway, by zinc-sensing receptor ZnR/GPR39-dependent upregulation of TNFAIP3 gene expression. Silencing of TNFAIP3 in VSMCs blunted the anticalcific effects of ZnSO₄ under high phosphate conditions. kl/kl mice showed reduced plasma zinc levels, and ZnSO₄ supplementation strongly blunted vascular calcification and aortic osteoinduction and upregulated aortic Tnfaip3 expression. ZnSO₄ ameliorated vascular calcification in mice with chronic renal failure and mice with cholecalciferol overload. In patients with CKD, serum zinc concentrations inversely correlated with serum calcification propensity. Finally, ZnSO₄ ameliorated the osteoinductive effects of uremic serum in VSMCs.Conclusions Zinc supplementation ameliorates phosphate-induced osteo-/chondrogenic transdifferentiation of VSMCs and vascular calcification through an active cellular mechanism resulting from GPR39-dependent induction of TNFAIP3 and subsequent suppression of the NF-κB pathway. Zinc supplementation may be a simple treatment to reduce the burden of vascular calcification in CKD.

Survey of urinary nickel in peritoneal dialysis patients

This study surveyed urinary nickel concentrations in peritoneal dialysis (PD) patients, and analyzed the association of urinary nickel concentrations with clinical outcomes and inflammatory biomarkers. In total, 50 PD patients and 50 healthy controls were recruited for this study. All participants were examined for the presence of toxic trace elements (antimony, arsenic, bismuth, cadmium, copper, manganese, mercury, nickel, lead, tellurium, thallium and zinc) in their urine by using inductively coupled plasma mass spectrometry (ICP-MS). It was found that PD patients demonstrated higher urinary nickel concentrations than healthy controls (6.1±3.5 versus 2.8±1.4 μg/L, P<0.001). There were 24 (48.0%) PD patients with normal urinary nickel concentrations, and 26 (52.0%) PD patients with high urinary nickel concentrations. The PD patients with high urinary nickel concentrations demonstrated higher log serum levels of high sensitivity C-reactive protein (0.4±0.5 versus 0.1±0.5 mg/L, P=0.046) than patients with normal urinary nickel concentrations. Furthermore, patients with high urinary nickel concentrations exhibited higher levels of cadmium (1.3±0.9 versus 0.6±0.5 μg/L, P<0.001), copper (7.7±5.7 versus 3.3±1.4 μg/L, P<0.001) and manganese (0.9±1.1 versus 0.4±0.4 μg/L, P=0.023) than patients with normal urinary nickel concentrations. Nevertheless, there were no significant differences in the clinical outcomes between PD patients with high and normal urinary nickel concentrations (P>0.05). Thus, it is concluded that approximately half of the patients undergoing PD had elevated urinary nickel levels, and these patients also had elevated serum levels of high sensitivity C-reactive protein. Nevertheless, no other real correlations were discovered including no impact on patient outcome. Further studies are warranted.