Selenium Associates With Response to Erythropoiesis-Stimulating Agents in Hemodialysis Patients

Yasukawa, Minoru; Arai, Shigeyuki; Nagura, Michito; Kido, Ryō; Asakawa, Shinichiro; Hirohama, Daigoro; Tamura, Yoshifuru; Fujimaki, Michitaka; Kobayashi, Sawako; Mimaki, Masakazu; Kodama, Hiroko; Uchida, Shunya; Fujigaki, Yoshihide; Shibata, Shigeru

doi:10.1016/j.ekir.2022.04.009

Cited by 7 publications

(6 citation statements)

References 54 publications

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“…In this current issue of the KI Reports, Yasukawa et al 9 The authors observed a significant inverse correlation between serum selenium levels and ERI but not with Hb, transferrin saturation, or ferritin. The independent association between serum selenium levels and ERI (>9.44 in this cohort) was then confirmed by multiple regression analyses, after adjustment by potential confounding factors (gender, cardiovascular disease, dialysis vintage, ferritin, transferrin saturation, albumin, C-reactive protein, zinc, and parathyroid hormone levels).…”

Section: See Clinical Research On Page 1565mentioning

confidence: 84%

“Trace” the Element: The Plausible Role Played by Selenium in the Erythropoietin Hyporesponsiveness

Azancot

Ureña-Torres

Touzot

2022

Kidney International Reports

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Section: See Clinical Research On Page 1565mentioning

confidence: 84%

“Trace” the Element: The Plausible Role Played by Selenium in the Erythropoietin Hyporesponsiveness

Azancot

Ureña-Torres

Touzot

2022

Kidney International Reports

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“…When patients were divided according to selenium levels and iron status, both low serum selenium (<10.5 µg/dL) and iron deficiency significantly affected the response to ESA. Finally, the association of low serum selenium with ESA hyporesponsiveness persisted after adjustment of confounding variables [40].…”

Section: Selenium Deficiency In Dialysis Patientsmentioning

confidence: 87%

Trace Elements and Their Management in Dialysis Patients—Pathophysiology and Clinical Manifestations

Wakino

2023

Kidney and Dialysis

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Recently, as the number of elderly dialysis patients has been increasing, complications associated with low nutritional status such as infectious disease have had a strong influence on the prognosis of dialysis patients. Nutritional disorders are caused by the inadequate intake of the three major nutrients—proteins, fats, and carbohydrates—as well as vitamin and mineral deficiencies. Minerals are composed of various elements, including small-amount elements and trace elements, which are present in the human body in very small quantities lower than that of iron. In dialysis and predialysis patients, zinc, manganese, and selenium are the three major elements that are significantly depleted as compared to normal subjects; these deficiencies are sometimes symptomatic. Zinc deficiency is manifest as anemia, taste abnormality, and delayed wound healing, while selenium deficiency is associated with impaired cardiac function and immunocompromised condition. Zinc has multiple functions, since various enzymes, including DNA polymerase and RNA polymerase, need zinc as a cofactor, while selenium is a component of selenoproteins, including glutathione peroxidase and thioredoxin reductases, which are major antioxidative stress enzymes. These elements can only be supplemented exogenously and contribute to the sustainable QOL of dialysis patients. On the other hand, as regards other trace elements, including copper, chromium, manganese, lead, arsenic, etc., the association of their deficiency or intoxication with various involvements of dialysis patients were investigated, although all investigations were performed in cross-sectional studies or observational studies. Therefore, the supplementation of these elements is inconclusive, given the scarcity of other intervention studies. More conclusive studies are endorsed for the establishment of proper supplementation strategies.

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“…Although the pathophysiology of the roles of micronutrients in HD patients is poorly understood, epidemiological studies have shown positive associations between micronutrients and HD patient outcomes. A cross-sectional study evaluated the association between the response to ESAs and selenium levels in HD patients in Japan [ 18 ]. Their study showed an inverse association in response to ESAs based on selenium levels, and this association was independent of iron status.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients

Kang

Kim

Son

et al. 2023

JCM

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This study aimed to evaluate the difference in patient survival according to the type of erythropoiesis-stimulating agent (ESA) treatment used in the Korean hemodialysis (HD) population. This retrospective study analyzed the laboratory data from a national HD quality assessment program and the claims of Korea. Included participants were divided into three groups according to the type of ESA used during the 6 months of each assessment period as follows: the EP group (n = 38,043, epoetin-α or epoetin-β), the DP group (n = 10,054, darbepoetin-α), and the MR group (2253, continuous erythropoietin receptor activator). The ESA doses in the EP, DP, and MR groups were 6451 ± 3586, 5959 ± 3857, and 3877 ± 2275 unit/week, respectively. The erythropoiesis resistance indexes (ERIs) in the three groups were 10.7 ± 6.7, 9.9 ± 7.6, and 6.3 ± 4.1 IU/kg/g/dL, respectively. Kaplan–Meier curves revealed similar rates of patient survival among the three groups (p = 0.530). A multivariate Cox regression analysis showed that the hazard ratios in the DP group and MR group were 1.00 (p = 0.853) and 0.87 (p < 0.001), respectively, compared to that of the EP group. The hazard ratio in the MR group was 0.87 (p = 0.001) compared to that of the DP group. Our study shows that the MR group had comparable or better patient survival than the EP and DP groups in the multivariate analysis. However, the ESA doses and ERI were considerably different among the three groups. It was difficult to determine whether the better patient survival in the MR group originated from the ESA type, ESA dose, ERI, or other hidden factors.

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Selenium Associates With Response to Erythropoiesis-Stimulating Agents in Hemodialysis Patients

Cited by 7 publications

References 54 publications

“Trace” the Element: The Plausible Role Played by Selenium in the Erythropoietin Hyporesponsiveness

“Trace” the Element: The Plausible Role Played by Selenium in the Erythropoietin Hyporesponsiveness

Trace Elements and Their Management in Dialysis Patients—Pathophysiology and Clinical Manifestations

Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients

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