Trace Minerals in Patients with End‐Stage Renal Disease

Abstract

The kidneys are famously responsible for maintaining external balance of prevalent minerals, such as sodium, chloride, and potassium. The kidney's role in handling trace minerals is more obscure to most nephrologists. Similarly, the impact of kidney failure on trace mineral metabolism is difficult to anticipate. The associated dietary modifications and dialysis create the potential for trace mineral deficiencies and intoxications. Indeed, there are numerous reports of dialysis-associated mishaps causing mineral intoxication, notable for the challenge of assigning causation. Equally challenging has been the recognition of mineral deficiency syndromes, amid what is often a cacophony of multiple comorbidities that vie for the attention of clinicians who care for patients with chronic kidney disease. In this paper, I review a variety of minerals, some of which are required for maintenance of normal human physiology (the U.S. Food and Drug Administration's list of essential minerals), and some that have attracted attention in the care of dialysis patients. For each mineral, I will discuss its role in normal physiology and will review reported deficiency and toxicity states. I will point out the interesting inter-relationships between several of the elements. Finally, I will address the special concerns of aluminum and magnesium as they pertain to the dialysis population.

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

“…These elements play an important role in human health and are recognized by the U.S. Department of Agriculture (USDA) as essential TEs [8]. Other TEs like arsenic (As) and lead (Pb) are potentially harmful to humans [8]. …”

Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

“…The fourth most abundant cation in the human body, magnesium is, like potassium, predominantly intracellular. It is critically involved in energy metabolism, enzyme functions and participates in the regulation of PTH synthesis, release, and action (30). Low magnesium levels have been associated with impairment of myocardial contractility, intradialytic hemodynamic instability, and hypotension.…”

Oxocomplexes of Mo(vi) and W(vi) with 8-hydroxyquinoline-5-sulfonate in solution: structural studies and the effect of the metal ion on the photophysical behaviour

“…[5][6][7] The aqueous coordination chemistries of molybdenum and tungsten are similar, and among the whilst under acidic conditions, condensation leads to the generation of polyoxometalates. 18,19 Although considered an essential element, toxicological studies on molybdenum compounds reveal that above certain critical levels in the diets of animals they can be linked to health disorders, such as amino acid intolerance, interference with copper homeostasis, increased concentration of serum uric acid, 19,20 gout, gout-like symptoms and arthritis in humans. This maximizes π-bonding through interactions with three metal d π orbitals.…”

“…6,8,9,10 In the presence of chelating ligands, these metals can increase their coordination number up to six to form distorted octahedral complexes, with the two strong π-donating oxo ligands generally in a cis configuration. 19,20 Molybdenum may also be toxic to the male reproductive system 20 and, as MoO 3 , be related to some cases of pneumoconiosis, leading to lung damage. As a consequence, unsymmetrical chelate ligands coordinate preferentially with the weaker donor positioned trans to the oxo ligands to avoid competition for the same d orbitals.…”