Trace Metals' Abnormalities in Hemodialysis Patients: Relationship with Medications

Abstract

A multicenter collaborative study was performed to investigate the prevalence of abnormal blood contents of 6 trace metals, copper (Cu), zinc (Zn), aluminum (Al), lead (Pb), cadmium (Cd), and mercury (Hg), in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3, Ca acetate, Al containing phosphate-binding agents, 1,25-dihydroxy vitD3, 1-hydroxy vitD3, and erythropoietin (EPO), as well as hematocrit level, by chi-square statistics. From 6 medical centers in Taiwan, we included 456 patients in maintenance HD for more than 4 months for this study, and they had continued the previously mentioned medications for at least 3 months. Blood samples were collected before initiating HD, and atomic absorption spectrophotometry was used to measure plasma levels of Cu, Zn, and Al as well as whole blood levels of Pb, Cd, and Hg. Three hundred seventy-five (78%) of the HD patients had low plasma Zn levels, that is, <800 microg/L, and the mean (+/-SD) concentration was 705.8 (+/-128.23) microg/L in all subjects. One hundred forty-one (31%) of the HD patients had high plasma Al, that is, >50 microg/L, and the mean (+/-SD) was 44.30 (+/-28.28) microg/L in all subjects. Three hundred thirty-three (73%) of the dialysis patients had high Cd levels, that is, >2.5 microg/L, and the mean (+/-SD) was 3.32 (+/-1.49) microg/L in all subjects. The majority of HD patients had normal blood levels of Cu, PB, and Hg. Only 21 (4. 6%), 5 (1.1%), and 3 (0.06%) patients had elevated blood levels of Cu, Pb, and Hg, respectively. Their mean (+/-SD) blood concentration of Cu, Pb, and Hg were 1,049.78 (+/-233.25) microg/L, 7.45 (+/-3.95) microg/dL, and 3.17 (+/-25.56) microg/L, respectively. Three patients had elevated plasma Hg concentrations, that is, 546, 12.6, and 24.0 microg/L, respectively. In the 152 normal healthy age and sex matched control group, the blood levels of Al, Cd, and Pb were all significantly lower than the HD patients. However, the levels of Cu and Zn were higher in the control group. The Hg level was not significantly different in both groups. There was no statistical difference between patients with normal and abnormal blood levels of trace metals in various medications except Al containing phosphate binder. The Al containing phosphate binder users had significantly higher plasma Al levels (54.71 +/- 26.70 versus 41.15 +/- 28.03 microg/L, p < 0.001) and hematocrit levels (29.61 +/- 4.61 versus 27. 81 +/- 3.91, p < 0.0005). There was no statistical correlation between erythropoietin (EPO) dose and hematocrit level in these patients. In conclusion, the blood level of trace metals of these HD patients except Al was not related to their medications. However, caution must be exercised in interpreting this result as dose and duration of medication; efficiency of HD and water treatment may play an important role. Otherwise, environmental factors, diet, and the aging process may contribute to the trace metal burden in uremia. Thus, Zn and Cu are abundant in seafood, and Cd is abundant in contam...

Blood Lead in End-Stage Renal Disease (ESRD) Patients who were on Maintainence Haemodialysis

“…Bing Chen et al, who studied the whole blood and the serum samples of Chinese stable chronic renal failure patients, haemodialysis patients, post-transplant patients and subjects with normal renal functions, found a low prevalence of the elevated lead levels (>200 µg/L) in the dialysis patients, which was similar to the findings of Su-Hui Lee et al, [9,10]. Ja-Liang Lin et al, studied the blood lead levels in 315 patients who were on chronic peritoneal dialysis in an 18-month prospective study.…”

Blood Arsenic and Cadmium Concentrations in End-Stage Renal Disease Patients who were on Maintenance Haemodialysis

“…Sharupskiene et al had also reported elevated blood cadmium levels in haemodialysis patients [34]. Su-Hui Lee et al, reported elevated cadmium levels in haemodialysis patients; 333 (73%) out of the 456 haemodialysis patients had high cadmium levels (>2.5 μg/L), and the mean concentration was 3.32 ± 1.49 μg/L [35].…”

Comment on:Does Zinc Supplementation Affect Inflammatory Markers in Hemodialysis Patients?

“…7,8 The rate of zinc deficiency in patients with HD is about 40-78%. [9][10][11] In a prospective cohort study, the effects of oral zinc sulfate supplementation on serum CRP, erythrocyte sedimentation rate (ESR), and ferritin level in HD patients were studied. From 155 patients with endstage renal disease on HD in the outpatient HD unit, 41 patients with low Zn level (Zn < 70 μg/mL) and normal serum iron were included in the study.…”