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Oliveira Júnior WVD, Giarola LTP, Ferreira LGR, Schettini IVG, Turani SD, Oliveira ARD, Marinho MAS, Pinto SWL, Barros-Pinheiro M, Figueiredo RCD, Rios DRA. Inflammation and all-cause mortality in patients undergoing peritoneal dialysis. EINSTEIN-SAO PAULO 2024; 22:eAO0627. [PMID: 39140572 DOI: 10.31744/einstein_journal/2024ao0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/08/2023] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate inflammatory biomarkers in patients undergoing peritoneal dialysis and investigate their association with all-cause mortality or transfer to hemodialysis. METHODS This prospective cohort study included 43 patients undergoing peritoneal dialysis. Plasma levels of cytokines were measured using flow cytometry and capture enzyme-linked immunosorbent assay. Biomarkers were categorized based on their respective median values. Survival analysis was conducted using the Kaplan-Meier estimator, considering two outcomes: all-cause mortality and transfer to hemodialysis. RESULTS After adjusting for confounding factors, plasma levels above the median of the levels of CCL2 and plasma, as well as below the median of TNF-α, and the median of dialysate IL-17 levels, were associated with an increased risk of experiencing the specified outcomes after approximately 16 months of follow-up. CONCLUSION These findings suggest that inflammatory biomarkers may be a valuable tool for predicting all-cause mortality and transfer to hemodialysis in patients undergoing peritoneal dialysis.
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Mansoori A, Ghiasi Hafezi S, Ansari A, Arab Yousefabadi S, Kolahi Ahari R, Darroudi S, Eshaghnezhad M, Ferns G, Ghayour-Mobarhan M, Esmaily H, Effati S. Serum Zinc and Copper Concentrations and Dyslipidemia as Risk Factors of Cardiovascular Disease in Adults: Data Mining Techniques. Biol Trace Elem Res 2024:10.1007/s12011-024-04288-0. [PMID: 38956010 DOI: 10.1007/s12011-024-04288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
This study aimed to examine the relationship between serum cholesterol levels and the ratio of zinc (Zn) and copper (Cu) in the blood serum and the incidence of cardiovascular disease (CVD). In Phase I of the study, 9704 individuals between the age of 35 and 65 years were recruited. Phase II of the cohort study comprised 7561 participants who completed the 10-year follow-up. The variables which were measured at the baseline of the study included gender, age, systolic blood pressure (SBP), diastolic blood pressure (DBP); biochemical parameters including serum Cu, Zn, copper-zinc ratio (Cu/Zn), zinc-copper ratio (Zn/Cu); fasted lipid profile consisting of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) as well as fasting serum glucose, and triglycerides-glucose (TyG) index. Decision tree (DT) and logical regression (LR) models were applied to examine the relationship between the aforementioned factors and CVD. CVD was diagnosed in 837 individuals (378 males and 459 females) out of 7561 participants. According to the LR models, SBP, TC, HDL, age, Zn/Cu, and TyG index for males and SBP, age, TyG index, HDL, TC, Cu/Zn, and Cu for females had the highest correlation with CVD (p-value ≤ 0.033). Based on the DT algorithm, 88% of males with SPB < 129.66 mmHg, younger age (age < 53 years), TyG index < 9.53, 173 ≤ TC < 187 mg/dL, and HDL ≥ 32 mg/dL had the lowest risk of CVD. Also, 98% of females with SBP < 128 mmHg, TyG index < 9.68, age < 44, TC < 222 mg/dL, and HDL ≥ 63.7 mg/dL had the lowest risk of CVD. It can be concluded that the Zn/Cu for men and Cu/Zn for women, along with dyslipidemia and SBP, could significantly predict the risk of CVD in this cohort from northeastern Iran.
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Affiliation(s)
- Amin Mansoori
- Department of Applied Mathematics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Somayeh Ghiasi Hafezi
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arina Ansari
- Student Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sahar Arab Yousefabadi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rana Kolahi Ahari
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Darroudi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Vascular and endovascular surgery research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Eshaghnezhad
- Department of Applied Mathematics, Faculty of Basic Sciences, Shahid Sattari University of Aeronautical Science and Technology, Tehran, Iran
| | - Gordon Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Majid Ghayour-Mobarhan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Sohrab Effati
- Department of Applied Mathematics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
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Chen CH, Huang SC, Huang SW, Tsai SF, Huang YC. Trace Elements Status and Their Associations With Related Antioxidant Enzyme Activities in Patients Receiving Peritoneal Dialysis and Hemodialysis. J Ren Nutr 2024; 34:243-251. [PMID: 38007184 DOI: 10.1053/j.jrn.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
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.
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Affiliation(s)
- Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Ph.D. Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung-Hsing University, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Shih-Chien Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, Taiwan; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Szu-Wei Huang
- Department of Nutrition, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chia Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, Taiwan; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Istanbuly O, Belcher J, Tabinor M, Solis-Trapala I, Lambie M, Davies SJ. Estimating the association between systemic Interleukin-6 and mortality in the dialysis population. Re-analysis of the global fluid study, systematic review and meta-analysis. BMC Nephrol 2023; 24:312. [PMID: 37884903 PMCID: PMC10601265 DOI: 10.1186/s12882-023-03370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Systemic inflammation, measured as circulating Interleukin-6 (IL-6) levels, is associated with cardiovascular and all-cause mortality in chronic kidney disease. However, this has not been convincingly demonstrated in a systematic review or a meta-analysis in the dialysis population. We provide such evidence, including a re-analysis of the GLOBAL Fluid Study. METHODS Mortality in the GLOBAL fluid study was re-analysed using Cox proportional hazards regression with IL-6 levels as a covariate using a continuous non-logarithmic scale. Literature searches of the association of IL-6 levels with mortality were conducted on MEDLINE, EMBASE, PyschINFO and CENTRAL. All studies were assessed for risk of bias using the QUIPS tool. To calculate a pooled effect size, studies were grouped by use of IL-6 scale and included in the meta-analysis if IL-6 was analysed as a continuous linear covariate, either per unit or per 10 pg/ml, in both unadjusted or adjusted for other patient characteristics (e.g. age, comorbidity) models. Funnel plot was used to identify potential publication bias. RESULTS Of 1886 citations identified from the electronic search, 60 were included in the qualitative analyses, and 12 had sufficient information to proceed to meta-analysis after full paper screening. Random effects meta-analysis of 11 articles yielded a pooled hazard ratio (HR) per pg/ml of 1.03, (95% CI 1.01, 1.03), [Formula: see text]= 81%. When the analysis was confined to seven articles reporting a non-adjusted HR the result was similar: 1.03, per pg/ml (95% CI: 1.03, 1.06), [Formula: see text]=92%. Most of the heterogeneity could be attributed to three of the included studies. Publication bias could not be determined due to the limited number of studies. CONCLUSION This systematic review confirms the adverse association between systemic IL-6 levels and survival in people treated with dialysis. The heterogeneity that we observed may reflect differences in study case mix. SYSTEMATIC REVIEW REGISTRATION PROSPERO - CRD42020214198.
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Affiliation(s)
- Obaida Istanbuly
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - John Belcher
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Matthew Tabinor
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Ivonne Solis-Trapala
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Simon J Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK.
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Chen Z, Wang Y. Interleukin-6 levels can be used to estimate cardiovascular and all-cause mortality risk in dialysis patients: A meta-analysis and a systematic review. Immun Inflamm Dis 2023; 11:e818. [PMID: 37102647 PMCID: PMC10132186 DOI: 10.1002/iid3.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Although previous studies have explored the correlation of interleukin (IL)-6 with mortality risk in dialysis patients, the findings have been conflicting. Hence, this meta-analysis aimed to comprehensively assess the use of IL-6 measurement for estimating cardiovascular mortality and all-cause mortality in dialysis patients. METHODS The Embase, PubMed, Web of Science, and MEDLINE databases were searched to identify relevant studies. After screening out the eligible studies, the data were extracted. RESULTS Twenty-eight eligible studies with 8370 dialysis patients were included. Pooled analyses revealed that higher IL-6 levels were related to increased cardiovascular mortality risk (hazard ratio [HR] = 1.55, 95% confidence interval [CI]: 1.20-1.90) and all-cause mortality risk (HR = 1.11, 95% CI: 1.05-1.17) in dialysis patients. Further subgroup analyses suggested that higher IL-6 levels were associated with elevated cardiovascular mortality in hemodialysis patients (HR = 1.59, 95% CI: 1.36-1.81) but not in peritoneal dialysis patients (HR = 1.56, 95% CI: 0.46-2.67). Moreover, sensitivity analyses indicated that the results were robust. Egger's test revealed potential publication bias among studies exploring the correlation of IL-6 levels with cardiovascular mortality (p = .004) and all-cause mortality (p < .001); however, publication bias was not observed when using Begg's test (both p > .05). CONCLUSIONS This meta-analysis reveals that higher IL-6 levels could indicate higher risks of cardiovascular mortality and all-cause mortality in dialysis patients. These findings suggest that monitoring IL-6 cytokine may help to enhance dialysis management and improve the general prognosis of patients.
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Affiliation(s)
- Zeyu Chen
- Department of Cardiology, The First People's Hospital of Ziyang, Ziyang, China
| | - Yan Wang
- Department of Nephrology, The First People's Hospital of Ziyang, Ziyang, China
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Clinical Significance of Trace Element Zinc in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:jcm12041667. [PMID: 36836202 PMCID: PMC9964431 DOI: 10.3390/jcm12041667] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
The trace element zinc is essential for diverse physiological processes in humans. Zinc deficiency can impair growth, skin reproduction, immune function, maintenance of taste, glucose metabolism, and neurological function. Patients with chronic kidney disease (CKD) are susceptible to zinc deficiency, which is associated with erythropoiesis-stimulating agent (ESA) hypo-responsive anemia, nutritional problems, and cardiovascular diseases as well as non-specific symptoms such as dermatitis, prolonged wound healing, taste disturbance, appetite loss, or cognitive decline. Thus, zinc supplementation may be useful for the treatment of its deficiency, although it often causes copper deficiency, which is characterized by several severe disorders including cytopenia and myelopathy. In this review article, we mainly discuss the significant roles of zinc and the association between zinc deficiency and the pathogenesis of complications in patients with CKD.
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Oruc M, Mercan S, Bakan S, Kose S, Ikitimur B, Trabulus S, Altiparmak MR. Do trace elements play a role in coronary artery calcification in hemodialysis patients? Int Urol Nephrol 2023; 55:173-182. [PMID: 35854190 DOI: 10.1007/s11255-022-03303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 07/07/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Abnormalities of trace elements have previously been linked to inflammatory processes in hemodialysis (HD) patients. We aimed to establish the trace element status of maintenance HD patients, to investigate the relationship between coronary artery calcification scores (CACs) and whole blood levels of trace elements. METHODS Patients undergoing HD in three times a week for > 6 months and age-and sex-matched controls were included from October 2015 to June 2016. Data were collected from patient files. All subjects' whole blood levels of trace elements were measured by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). CACs for patients were assessed by multi-detector computed tomography. RESULTS The 35 patients (male, 60%) with a mean age of 45.7 ± 10.4 years and 35 controls were included. HD patients showed significantly lower levels of selenium and uranium and higher cadmium (Cd), cobalt, lithium, manganese, nickel, lead, platinum, tin, strontium, and thallium levels compared to controls. Coronary artery calcification (CAC) was present in 21 patients (60%), and median CACs were 14.2 (IQR 0-149). Patients with CACs > median were significantly older, had a higher prevalence of hypertension and lower ALP levels than patients with CACs ≤ median. No significant differences in whole blood levels of trace elements were found between patients with CACs > median and patients with CACs ≤ median. A near significance was noted in median whole blood levels of Cd between these groups (P = 0.096). According to multivariate analysis, age was the only independent determinant for CAC development. CONCLUSION Age is independently associated with coronary vascular calcification. High Cd levels might play a role in CAC development in HD patients.
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Affiliation(s)
- Meric Oruc
- Department of Nephrology, Kartal Dr Lutfi Kirdar City Hospital, 34865, Istanbul, Turkey.
| | - Selda Mercan
- Department of Science, Institute of Forensic Sciences and Legal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selim Bakan
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sennur Kose
- Department of Nephrology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Baris Ikitimur
- Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Elgenidy A, Amin MA, Awad AK, Husain-Syed F, Aly MG. Serum Zinc Levels in Chronic Kidney Disease Patients, Hemodialysis Patients, and Healthy Controls: Systematic Review and Meta-Analysis. J Ren Nutr 2023; 33:103-115. [PMID: 35472507 DOI: 10.1053/j.jrn.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/23/2022] [Accepted: 04/15/2022] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Faeq Husain-Syed
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany; International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Mostafa G Aly
- Nephrology Unit, Internal Medicine Department, Assiut University, Assiut, Egypt; Transplantation Immunology, Institute of Immunology, University Hospital Heidelberg, Germany; Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany.
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Maša K, Nejc P, Robert E, Radovan H, Sebastjan B. Serum zinc values, ankle brachial index and mortality in hemodialysis patients. BMC Nephrol 2022; 23:355. [PMCID: PMC9635065 DOI: 10.1186/s12882-022-02982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The atherosclerotic state of haemodialysis (HD) patients may be influenced by heavy metals. The purpose of our study was to assess the relationship between serum zinc (Zn) ankle brachial index (ABI) as a non-invasive diagnostic tool for atherosclerosis, and mortality in chronic haemodialysis (HD) patients. Methods Sixty one HD patients were included (mean age 61.2 ± 13.8 years). The ABI was measured with an automated measuring device (ABPI MD, MESI®, Slovenia). Two groups of patients were formed based on the median value of Zn (14.1 mcmol/l). The average observation time was 2.8 years. Comorbidities (arterial hypertension (AH), diabetes mellitus (DM), dyslipidaemia), smoking and oral nutritional supplements (ONS) consumption were noted. Survival rates were analysed by Kaplan–Meier and Cox regression was used to determine the influence of Zn, ABI, AH, DM, dyslipidaemia, smoking and ONS. Results Zn values were between 9.2 and 23.5 mcmol/l (14.4 ± 2.34), ABI values ranged from 0.8 to 1.4 (1.14 ± 0.12). Patients with lower Zn values had lower ABI (p = 0.036). Mean survival time of patients with higher Zn values was 985 days ± 277 days and with lower Zn values 1055 ± 143 days. Six (19.4%) patients with lower Zn and five (16.7%) patients with higher Zn died. We found statistically insignificant lower survival in patients with higher Zn. We failed to find any predictor of all-cause mortality, except for ONS consumption (95% CI 1.6–33.3; p = 0.012). Conclusions Lower Zn is associated with lower ABI in HD patients, but we found no impact of Zn on patient survival.
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Affiliation(s)
- Knehtl Maša
- grid.412415.70000 0001 0685 1285Department of Nephrology, Clinic of Internal Medicine, University Medical Center Maribor, Maribor, Slovenia ,grid.8647.d0000 0004 0637 0731Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Piko Nejc
- grid.412415.70000 0001 0685 1285Department of Dialysis, Clinic of Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
| | - Ekart Robert
- grid.8647.d0000 0004 0637 0731Faculty of Medicine, University of Maribor, Maribor, Slovenia ,grid.412415.70000 0001 0685 1285Department of Dialysis, Clinic of Internal Medicine, University Medical Center Maribor, Maribor, Slovenia
| | - Hojs Radovan
- grid.412415.70000 0001 0685 1285Department of Nephrology, Clinic of Internal Medicine, University Medical Center Maribor, Maribor, Slovenia ,grid.8647.d0000 0004 0637 0731Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Bevc Sebastjan
- grid.412415.70000 0001 0685 1285Department of Nephrology, Clinic of Internal Medicine, University Medical Center Maribor, Maribor, Slovenia ,grid.8647.d0000 0004 0637 0731Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Micronutrients and Renal Outcomes: A Prospective Cohort Study. Nutrients 2022; 14:nu14153063. [PMID: 35893916 PMCID: PMC9370256 DOI: 10.3390/nu14153063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Micronutrients are essential in maintaining normal human physiology. Data regarding the association between micronutrients and renal outcomes in chronic kidney disease (CKD) are lacking. Methods: This prospective observational cohort study enrolled 261 patients with CKD stages 1−5 and 30 subjects with normal renal function. Baseline serum zinc (Zn), selenium (Se), chromium, manganese, and copper, and laboratory tests were performed at enrolment. The primary endpoint was the presence of end-stage renal disease (ESRD) requiring long-term renal replacement therapy. Results: The median follow-up periods of renal and non-renal survivals were 67.78 and 29.03 months, respectively. Multiple linear regression showed that Zn and Se (β ± SE: 24.298 ± 8.616, p = 0.005; 60.316 ± 21.875, p = 0.006, respectively) levels were positively correlated with renal function. Time to ESRD was significantly longer for those with Zn levels ≥1287.24 ng/g and Se levels ≥189.28 ng/g (both p < 0.001). Cox regression analysis identified a higher Zn level as an independently negative predictor of ESRD after adjusting for renal function (hazard ratio, 0.450, p = 0.019). Conclusion: Serum Se and Zn concentrations are positively associated with renal function and better renal outcomes. A higher Zn concentration could independently predict better renal survival.
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Gembillo G, Visconti L, Giuffrida AE, Labbozzetta V, Peritore L, Lipari A, Calabrese V, Piccoli GB, Torreggiani M, Siligato R, Santoro D. Role of Zinc in Diabetic Kidney Disease. Nutrients 2022; 14:nu14071353. [PMID: 35405968 PMCID: PMC9003285 DOI: 10.3390/nu14071353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022] Open
Abstract
Diabetic Kidney Disease (DKD) represents the most common cause of Chronic Kidney Disease (CKD) in developed countries. Approximately 30% to 40% of diabetes mellitus (DM) subjects develop DKD, and its presence significantly increases the risk for morbidity and mortality. In this context, Zinc seems to have a potential role in kidney and body homeostasis in diabetic individuals as well as in patients at a high risk of developing this condition. This essential element has functions that may counteract diabetes-related risk factors and complications, which include stabilization of insulin hexamers and pancreatic insulin storage and improved glycemic control. In our review, we analyzed the current knowledge on the role of zinc in the management of renal impairment in course of DM. Several studies underline the critical role of zinc in reducing oxidative stress levels, which is considered the common denominator of the mechanisms responsible for the progression of kidney disease. Reaching and maintaining a proper serum zinc level could represent a valuable target to reduce symptoms related to DM complications and contrast the progression of kidney impairment in patients with the high risk of developing end-stage renal disease. In conclusion, analyzing the beneficial role of zinc in this review would advance our knowledge on the possible strategies of DM and DKD treatment.
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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; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy;
- Correspondence: (G.G.); (D.S.)
| | - Luca Visconti
- Unit of Nephrology and Dialysis, Ospedali Riuniti Villa Sofia Cervello, University of Palermo, 90146 Palermo, Italy;
| | - Alfio Edoardo Giuffrida
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
| | - Vincenzo Labbozzetta
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
| | - Luigi Peritore
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
| | - Antonella Lipari
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
| | - Vincenzo Calabrese
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
| | - Giorgina Barbara Piccoli
- Néphrologie Et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 Le Mans, France; (G.B.P.); (M.T.)
| | - Massimo Torreggiani
- Néphrologie Et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 Le Mans, France; (G.B.P.); (M.T.)
| | - Rossella Siligato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy;
- Unit of Nephrology, Azienda Ospedaliera Universitaria Sant’Anna, 44124 Ferrara, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.E.G.); (V.L.); (L.P.); (A.L.); (V.C.)
- Correspondence: (G.G.); (D.S.)
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Abstract
Zinc is an essential trace element due to its role as a key part of human enzymatic activity. As a cofactor in metalloenzymes and metalloproteins, zinc participates in diverse biological functions, including gene transcription, translation, and replication, phagocytosis, and immunoglobulin and cytokine production. In this review, we will focus on the role of zinc in the cardiovascular system, including heart failure, vascular calcification, and myocardial infarction. We will further highlight the role of zinc in cardiovascular pathology in individuals with chronic kidney disease, and type II diabetes mellitus, groups uniquely at risk for cardiovascular morbidity and mortality.
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13
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Association of Zinc Deficiency with Development of CVD Events in Patients with CKD. Nutrients 2021; 13:nu13051680. [PMID: 34063377 PMCID: PMC8156917 DOI: 10.3390/nu13051680] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Deficiency of the micronutrient zinc is common in patients with chronic kidney disease (CKD). The aim of this review is to summarize evidence presented in literature for consolidation of current knowledge regarding zinc status in CKD patients, including those undergoing hemodialysis. Zinc deficiency is known to be associated with various risk factors for cardiovascular disease (CVD), such as increased blood pressure, dyslipidemia, type 2 diabetes mellitus, inflammation, and oxidative stress. Zinc may protect against phosphate-induced arterial calcification by suppressing activation of nuclear factor kappa light chain enhancer of activated B. Serum zinc levels have been shown to be positively correlated with T50 (shorter T50 indicates higher calcification propensity) in patients with type 2 diabetes mellitus as well as those with CKD. Additionally, higher intake of dietary zinc was associated with a lower risk of severe abdominal aortic calcification. In hemodialysis patients, the beneficial effects of zinc supplementation in relation to serum zinc and oxidative stress levels was demonstrated in a meta-analysis of 15 randomized controlled trials. Thus, evidence presented supports important roles of zinc regarding antioxidative stress and suppression of calcification and indicates that zinc intake/supplementation may help to ameliorate CVD risk factors in CKD patients.
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14
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Toida T, Toida R, Ebihara S, Takahashi R, Komatsu H, Uezono S, Sato Y, Fujimoto S. Association between Serum Zinc Levels and Clinical Index or the Body Composition in Incident Hemodialysis Patients. Nutrients 2020; 12:nu12103187. [PMID: 33086501 PMCID: PMC7603268 DOI: 10.3390/nu12103187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The relationships between serum zinc levels and body composition or clinical outcomes of incident hemodialysis (HD) patients remain unclear. Methods: This prospective observational study examined the relationships between serum zinc levels and clinical indexes, including body composition, in 142 incident HD patients using a bioelectrical impedance analysis. Patients were divided into three groups according to baseline serum zinc levels: tertile, <45, 45–59, and ≥60 µg/dL. The reference group was set as ≥60 µg/dL. Cox’s regression analysis was performed to investigate the relationships between serum zinc categories and cardiovascular events and all-cause mortality after adjustments for potential confounders. Results: Serum zinc levels positively correlated with the nutritional index and negatively correlated with fluid volume markers. In a mean follow-up of 2.5 years, there were 20 cases of cardiovascular events and 15 of all-cause mortality. In the Cox’s regression analysis for cardiovascular events and all-cause mortality, the hazard ratio increased with a decrease in serum zinc levels, but was not significant. Conclusion: Serum zinc levels were associated with nutritional and fluid volume markers in incident HD patients. To clarify the relationship between serum zinc levels and cardiovascular events or mortality, further studies with a larger number of cases will be necessary.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka 882-0835, Japan;
- Correspondence: ; Tel.: +83-985-85-1510
| | - Reiko Toida
- Department of Internal Medicine, Chiyoda Hospital, Hyuga 883-0064, Japan; (R.T.); (S.U.)
| | - Shou Ebihara
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
| | - Risa Takahashi
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka 882-0835, Japan;
| | - Hiroyuki Komatsu
- Center for Medical Education and Career Development, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
| | - Shigehiro Uezono
- Department of Internal Medicine, Chiyoda Hospital, Hyuga 883-0064, Japan; (R.T.); (S.U.)
| | - Yuji Sato
- Division of Nephrology, Department of Internal Medicine, National Health Insurance Takachiho Town Hospital, Takachiho 882-1101, Japan;
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan;
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15
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Cardozo LFMF, Mafra D. Don't forget the zinc. Nephrol Dial Transplant 2020; 35:1094-1098. [PMID: 32417896 DOI: 10.1093/ndt/gfaa045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/30/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Ludmila F M F Cardozo
- Post Graduation Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói-Rio de Janeiro (RJ), Brazil
| | - Denise Mafra
- Post Graduation Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói-Rio de Janeiro (RJ), Brazil.,Post Graduation Program in Medical Sciences, Federal Fluminense University (UFF), Niterói-Rio de Janeiro, Brazil
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16
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Tallman DA, Latifi E, Kaur D, Sulaheen A, Ikizler TA, Chinna K, Mat Daud ZA, Karupaiah T, Khosla P. Dietary Patterns and Health Outcomes among African American Maintenance Hemodialysis Patients. Nutrients 2020; 12:E797. [PMID: 32197373 PMCID: PMC7146457 DOI: 10.3390/nu12030797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022] Open
Abstract
The association between dietary patterns and health outcomes, such as quality of life (QOL), in maintenance hemodialysis (MHD) patients with certain racial backgrounds has not been studied in detail. QOL is a powerful outcome measure in which dietary patterns could be a modifying factor. This study is a secondary analysis examining the association between dietary patterns and health outcomes in 101 African American (AA) maintenance hemodialysis (MHD) patients participating in the Palm Tocotrienols in Chronic Hemodialysis (PATCH) study. Quality of life (QOL) was assessed using the Kidney Disease Quality of Life 36-item survey (KDQOL-36™). Blood samples were analyzed for lipids, lipoprotein subfractions, and inflammatory markers. Food intake was measured using six non-consecutive 24-h dietary recalls over 15 months. Implausible energy intake reports were screened out by comparing reported energy intake (rEI) with predicted total energy expenditure (pTEE). Cluster analysis, using the k-means algorithm, identified two distinct dietary patterns in the study population: a high "sugar sweetened beverage" pattern (hiSSB) and a low "sugar sweetened beverage pattern" (loSSB). In the hiSSB group, consumption of SSB accounted for ~28% of energy intake, while SSB represented only 9% of energy intake in the loSSB group. The hiSSB group was characterized by a higher intake of total calories, sugar and percentage of kilocalories from carbohydrates, whereas the percentage of kilocalories from protein and fat was lower. While additional micronutrient intakes differed between groups (vitamin C, zinc, chromium), these were significantly lower than recommended values in the entire cohort. Patients in the hiSSB group presented with lower high-density lipoprotein cholesterol (HDL-C), lower large HDL particles and smaller low density lipoprotein (LDL) particle diameters. Antidepressant usage was significantly higher in the hiSSB group. Patients in the hiSSB group scored lower across all five KDQOL domains and scored significantly lower in the mental composite domain. MHD patients following a hiSSB dietary pattern had smaller dense LDL particles, lower HDL-C, and a lower QOL. Suboptimal intakes of fruits, vegetables, and grains as well as key micronutrients were evident in both patterns.
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Affiliation(s)
- Dina A. Tallman
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA (E.L.); (D.K.)
| | - Eno Latifi
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA (E.L.); (D.K.)
| | - Deepinder Kaur
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA (E.L.); (D.K.)
| | - Ayesha Sulaheen
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia;
| | - T. Alp Ikizler
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Karuthan Chinna
- School of Medicine, Faculty of Health Sciences, Taylors University, 47500 Subang Jaya, Malaysia; (K.C.); (T.K.)
| | - Zulfitri Azuan Mat Daud
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Malaysia;
| | - Tilakavati Karupaiah
- School of Medicine, Faculty of Health Sciences, Taylors University, 47500 Subang Jaya, Malaysia; (K.C.); (T.K.)
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA (E.L.); (D.K.)
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17
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Silva RE, Simões-e-Silva AC, Miranda AS, Justino PBI, Brigagão MRPL, Moraes GOI, Gonçalves RV, Novaes RD. Potential Role of Nutrient Intake and Malnutrition as Predictors of Uremic Oxidative Toxicity in Patients with End-Stage Renal Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:7463412. [PMID: 31871556 PMCID: PMC6906803 DOI: 10.1155/2019/7463412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 12/25/2022]
Abstract
Oxidative stress is an important risk factor for cardiovascular disease and death in hemodialysis (HD) patients. However, whether biochemical and nutritional markers might be useful to stratify HD patients according to the risk of oxidative damage remains unclear. We investigated whether low-cost and easily available parameters such as the profile of nutrients intake, nutritional status, and antioxidant defenses can predict lipid and protein oxidation in HD patients. Forty-nine HD patients (women = 20, men = 29), ranging from 18 to 65 years of age (73.5%) were submitted to biochemical and nutritional analysis. At least 93.9% of HD patients had malnutrition. A patient's stratification according to nutritional risk was highly coherent with anthropometric parameters and nutrients intake, which were complementarily used as markers of malnutrition. Nutritional stratification was unable to reveal differences in the oxidative status. On the other hand, carbohydrate and zinc intake, serum zinc (Zn), glutathione peroxidase (GPx) activity, total antioxidant capacity (TAC), and nonprotein antioxidants (npAC) in serum were predictive markers of lipid (R 2 = 0.588, P < 0.001) and protein (R 2 = 0.581, P < 0.001) oxidation. Interestingly, GPx activity, TAC, and npAC exhibited good (>80% < 90%) or excellent (>90%) accuracy to estimate lipid oxidation (P ≤ 0.01). Regarding the prediction of protein oxidation, GPx activity and TAC presented regular accuracy (>70% < 80%), and Zn serum levels exhibited good sensitivity (P ≤ 0.01). Herein, we provided evidence that clinical characteristics relevant to predict different levels of lipid and protein oxidation in HD patients can be easily obtained, during routine hospital visits by means of the combined analyses of biochemical and nutritional parameters.
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Affiliation(s)
- Robson E. Silva
- School of Medicine, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
- University Hospital Alzira Velano, Alfenas, 37132-202 Minas Gerais, Brazil
| | - Ana C. Simões-e-Silva
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, 30130-100 Minas Gerais, Brazil
| | - Aline S. Miranda
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, 31270-910 Minas Gerais, Brazil
| | | | - Maísa R. P. L. Brigagão
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
| | - Gabriel O. I. Moraes
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
| | - Reggiani V. Gonçalves
- Department of Animal Biology, Federal University of Viçosa, Viçosa, 36570-000 Minas Gerais, Brazil
| | - Rômulo D. Novaes
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001 Minas Gerais, Brazil
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18
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Effect of Zinc Supplementation on Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis of 15 Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1024769. [PMID: 29457023 PMCID: PMC5804106 DOI: 10.1155/2017/1024769] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022]
Abstract
We aimed to examine the effects of zinc supplementation on nutritional status, lipid profile, and antioxidant and anti-inflammatory therapies in maintenance hemodialysis (MHD) patients. We performed a systematic review and meta-analysis of randomized, controlled clinical trials of zinc supplementation. Metaregression analyses were utilized to determine the cause of discrepancy. Begg and Egger tests were performed to assess publication bias. Subgroup analysis was utilized to investigate the effects of zinc supplementation in certain conditions. In the crude pooled results, we found that zinc supplementation resulted in higher serum zinc levels (weighted mean difference [WMD] = 28.489; P < 0.001), higher dietary protein intake (WMD = 8.012; P < 0.001), higher superoxide dismutase levels (WMD = 357.568; P = 0.001), and lower levels of C-reactive protein (WMD = −8.618; P = 0.015) and malondialdehyde (WMD = −1.275; P < 0.001). The results showed no differences in lipid profile. In the metaregression analysis, we found that serum zinc levels correlated positively with intervention time (β = 0.272; P = 0.042) and varied greatly by ethnicity (P = 0.023). Results from Begg and Egger tests showed that there was no significant bias in our meta-analysis (P > 0.1). Results of subgroup analysis supported the above results. Our analysis shows that zinc supplementation may benefit the nutritional status of MHD patients and show a time-effect relationship.
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19
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20
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Mafra D. Can Outcomes be Improved in Dialysis Patients by Optimizing Trace Mineral, Micronutrient, and Antioxidant Status?: The Role of Trace Elements. Semin Dial 2015; 29:48-50. [PMID: 26384706 DOI: 10.1111/sdi.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Denise Mafra
- Postgraduate Program of Cardiovascular Sciences and Postgraduate Program of Medical Sciences, Federal Fluminense University (UFF), Niterói/Rio de Janeiro, Brazil
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21
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Viramontes-Hörner D, Márquez-Sandoval F, Martín-del-Campo F, Vizmanos-Lamotte B, Sandoval-Rodríguez A, Armendáriz-Borunda J, García-Bejarano H, Renoirte-López K, García-García G. Effect of a Symbiotic Gel (Lactobacillus acidophilus + Bifidobacterium lactis + Inulin) on Presence and Severity of Gastrointestinal Symptoms in Hemodialysis Patients. J Ren Nutr 2015; 25:284-91. [DOI: 10.1053/j.jrn.2014.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/19/2014] [Accepted: 09/24/2014] [Indexed: 11/11/2022] Open
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22
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Palmer SC, Ruospo M, Campbell KL, Garcia Larsen V, Saglimbene V, Natale P, Gargano L, Craig JC, Johnson DW, Tonelli M, Knight J, Bednarek-Skublewska A, Celia E, del Castillo D, Dulawa J, Ecder T, Fabricius E, Frazão JM, Gelfman R, Hoischen SH, Schön S, Stroumza P, Timofte D, Török M, Hegbrant J, Wollheim C, Frantzen L, Strippoli GFM. Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: protocol for DIET-HD, a prospective multinational cohort study. BMJ Open 2015; 5:e006897. [PMID: 25795691 PMCID: PMC4368922 DOI: 10.1136/bmjopen-2014-006897] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the "DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study," a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries. METHODS AND ANALYSIS DIET-HD will recruit approximately 10,000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA(2)LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation. ETHICS AND DISSEMINATION The study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic trials of nutrition or dietary interventions in the setting of advanced kidney disease.
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Affiliation(s)
- Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Marinella Ruospo
- Diaverum Medical Scientific Office, Lund, Sweden
- Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Katrina L Campbell
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Vanessa Garcia Larsen
- Faculty of Medicine, National Health and Lung Institute, Imperial College of Science, Technology, and Medicine, Royal Brompton campus, London, UK
| | | | | | | | - Jonathan C Craig
- Sydney School of Public Health, Edward Ford Building, University of Sydney, Sydney, New South Wales, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta, Canada
| | - John Knight
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Bednarek-Skublewska
- Diaverum Medical Scientific Office, Lund, Sweden
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | | | | | - Jan Dulawa
- Diaverum Medical Scientific Office, Lund, Sweden
- Department of Internal Medicine, Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Tevfik Ecder
- Diaverum Medical Scientific Office, Lund, Sweden
| | | | - João Miguel Frazão
- Diaverum Medical Scientific Office, Lund, Sweden
- Nephrology and Infectiology Research and Development Group, INEB, and School of Medicine, Porto University, Porto, Portugal
| | | | | | | | | | | | | | | | | | - Luc Frantzen
- Diaverum Medical Scientific Office, Lund, Sweden
| | - G F M Strippoli
- Diaverum Medical Scientific Office, Lund, Sweden
- Sydney School of Public Health, Edward Ford Building, University of Sydney, Sydney, New South Wales, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Diaverum Academy, Bari, Italy
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23
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Ko KI, Park KS, Lee MJ, Doh FM, Kim CH, Koo HM, Oh HJ, Park JT, Han SH, Kang SW, Yoo TH. Increased dialysate MCP-1 is associated with cardiovascular mortality in peritoneal dialysis patients: a prospective observational study. Am J Nephrol 2014; 40:291-9. [PMID: 25323428 DOI: 10.1159/000368201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association between the dialysate MCP-1 (dMCP-1) and systemic inflammatory and nutritional markers in peritoneal dialysis (PD) patients. In addition, we examined the prognostic value of dMCP-1 on all-cause or cardiovascular mortality in these patients. METHODS We prospectively followed 169 prevalent PD patients from April 1st 2008 to December 31st 2012. At baseline, dMCP-1 and serum biochemical parameters including high sensitivity CRP (hs-CRP) and albumin were checked. All-cause mortality and cause of death were evaluated during the follow-up period. Based on the median level of dMCP-1, patients were classified as either low or high dMCP-1 groups. RESULTS Mean age, hs-CRP, and D/Pcr ratio at 4 h were significantly higher, while serum albumin levels and %lean body mass (LBM) were significantly lower in the high dMCP-1 group. During the mean follow-up period of 47.7 months, all-cause mortality and cardiovascular mortality rate were significantly higher in the high dMCP-1 group (9.6 and 6.3 per 100 person-years, respectively) compared to the low dMCP-1 group (5.1 and 3.1 per 100 person-years, respectively; p = 0.021, 0.038). In multivariate Cox analysis, high dMCP-1 was a significant independent predictor of all-cause mortality (hazard ratio: 1.83, 95% confidence interval: 1.03-3.24, p = 0.039). CONCLUSIONS dMCP-1 levels are closely correlated with nutritional and systemic inflammatory markers in PD patients. In addition, increased dMCP-1 is significantly associated with higher all-cause and cardiovascular mortality. These findings suggest that local peritoneal inflammation could contribute to poor clinical outcomes in PD patients.
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Affiliation(s)
- Kwang Il Ko
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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