Clinical factors associated with serum copper levels and potential effect of sevelamer in hemodialysis patients

Abstract

We found that serum copper levels were independently associated with dyslipidemia and inflammation in hemodialysis patients, but the pathogenic roles of copper remain to be elucidated. In addition, potential effect of sevelamer on serum copper levels should be examined in appropriately designed studies.

Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients

“…However, evidence that supplementation improves clinically relevant outcomes is lacking, and overt deficiency (values less than the fifth percentile from a referent population) was uncommon among participants in our study-which means that further investigation is required before supplementation could be recommended. Similarly, higher concentrations of copper in the general population have been linked with cardiovascular disease, anorexia (26), elevated blood concentrations of inflammatory markers (26,27), and perhaps, more rapid cognitive decline (28). However, most such data derive from toxicologic studies of acute or subacute exposure rather than the chronic low-concentration exposure that presumably occurs in patients on hemodialysis.…”

Effects of Zinc Supplementation on Plasma Copper/Zinc Ratios, Oxidative Stress, and Immunological Status in Hemodialysis Patients

“…Zn has antioxidant and anti-inflammatory properties and regulates T- and B-lymphocyte function, making it vital for the maintenance of normal immune function and resistance to infection 7,8. HD patients have elevated levels of plasma copper (Cu) and a markedly increased Cu/Zn ratios 9,10. Cu also acts as an antioxidant and anti-inflammatory agent and is required for immune function 11; accordingly, increased plasma levels of Cu and elevated Cu/Zn ratios are associated with nutritional abnormalities, oxidative stress, inflammation, and immune dysfunction 9,10,12.…”

“…HD patients have elevated levels of plasma copper (Cu) and a markedly increased Cu/Zn ratios 9,10. Cu also acts as an antioxidant and anti-inflammatory agent and is required for immune function 11; accordingly, increased plasma levels of Cu and elevated Cu/Zn ratios are associated with nutritional abnormalities, oxidative stress, inflammation, and immune dysfunction 9,10,12. The disruption of Zn and Cu levels has been suggested as a cause of clinical deterioration and adverse outcomes in HD patients.…”

Emerging Effects of Sevelamer in Chronic Kidney Disease

“…In our recent cross-sectional study, sevelamer hydrochloride dose inversely correlated with serum copper level in HD patients [44]. Veighey et al compared serum levels of zinc, copper, and selenium between HD patients treated with sevelamer hydrochloride and those treated with calcium- or lanthanum-containing phosphate binder [45].…”

“…Some studies have suggested associations between trace element metabolism and inflammation, oxidative stress, or atherosclerosis in HD patients [44,46,47]. The effect of sevelamer on trace element metabolism should be examined by further studies.…”