The Correlation of Serum Trace Elements and Heavy Metals with Carotid Artery Atherosclerosis in Maintenance Hemodialysis Patients

Abstract

Changes in essential trace elements and heavy metals may affect the atherosclerotic state of patients on maintenance hemodialysis (HD). The aim of the study was to evaluate the relation between the serum levels of some trace elements and heavy metals (iron, zinc, manganese, copper, magnesium, cobalt, cadmium, lead, and copper/zinc ratio) and carotid artery intima-media thickness (CIMT) in HD patients. Fifty chronic HD patients without known atherosclerotic disease and 48 age- and sex-matched healthy individuals were included in the study. The serum levels of trace elements (iron, zinc, manganese, copper, and magnesium) and heavy metals (cobalt, cadmium, and lead) were measured by Atomic Adsorption Spectrophotometer (UNICAM-929). CIMT was assessed by carotid artery ultrasonography. The serum levels of iron, zinc, and manganese were lower; levels of copper, magnesium, cobalt, cadmium, lead, and copper/zinc ratio were higher in HD patients compared to controls. CIMT in HD patients were higher than the control group (0.64 ± 0.11 vs 0.42 ± 0.05, p < 0.001). There was a significant negative correlation between CIMT and serum levels of zinc (r = -0.70, p < 0.01), iron (r = -0.71, p < 0.01), and manganese (r = -0.47, p < 0.01), while there was a significant positive correlation between CIMT and serum levels of copper (r = 0.63, p < 0.01), magnesium (r = 0.77, p < 0.01), cobalt (r = 0.63, p < 0.01), cadmium (r = 0.48, p < 0.01), lead (r = 0.38, p < 0.01), and copper/zinc ratio (r = 0.68, p < 0.01). A linear regression analysis showed that serum levels of magnesium, cadmium, lead, and copper/zinc ratio were still significantly and positively correlated with CIMT. We propose that copper/zinc ratio, magnesium and toxic metals cadmium and lead are independent determinants of CIMT in maintenance HD patients without known atherosclerotic disease.

Comparative Study on Trace Element Excretions between Nonanuric and Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

“…Anorexia, low taste sensibility, glucose intolerance, healing difficulties, anemia, malnutrition, and cardiovascular disease are common features and complications of CKD that can be associated with these alterations [10,11,12,13,14]. The positive effects of these element supplements on CKD patients are also supported by some research studies [19,20].…”

“…Especially, patients are at risk for low dietary intake of such substances which is attributable to uremia-related anorexia and dietary restrictions. Based on these, some essential TEs may be deficient, thereby causing some complications, which may further lead to an acceleration in disease progression [10,11,12,13,14]. On the other hand, toxic TEs that present in dialysis fluids but not in blood may accumulate.…”

Environmental Exposures and Cardiovascular Disease

“…Increased carotid intimal medial thickness has been observed in association with increased serum lead levels in a Turkish population with concomitant renal disease 136 . Lead exposure has also been associated with reduced heart rate variability and abnormalities of cardiac structure and function, including increased left ventricular hypertrophy and decreased ejection fraction 131 .…”

“…Cadmium has also been associated with cardiometabolic derangement including Type 2 Diabetes, as noted in a study from China 187 . Additionally, increased carotid intimal-medial thickness and carotid plaques also have been associated with cadmium exposure 136 .…”

Emerging Effects of Sevelamer in Chronic Kidney Disease

“…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.…”