Zinc is necessary for growth and cells’ division. Its deficiency may seriously affect antioxidant defense system and is usually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dialyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failure on regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis. Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentrations
decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrations tended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable

Luka Zaputović

Mira Ćuk

Sanjin Rački

Štefica Dvornik

English

Hrčak - Portal of scientific journals of Croatia

Coll. Antropol. 30 (2006) 1: 125–129Original scientific paperSerum Zinc Concentrations in the MaintenanceHemodialysis Patients[tefica Dvornik1, Mira ]uk2, Sanjin Ra~ki3 and Luka Zaputovi}31 Department of Laboratory Diagnostics, University Hospital Center Rijeka, Rijeka, Croatia2 Department of Physiology and Immunology, School of Medicine, University of Rijeka, Rijeka, Croatia3 Department of Internal Medicine, University Hospital Center Rijeka, Rijeka, CroatiaA B S T R A C TZinc is necessary for growth and cells' division. Its deficiency may seriously affect antioxidant defense system and isusually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dia-lyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failureon regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis.Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentra-tions decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrationstended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patientswith proven zinc deficiency, but for all chronic renal failure patients it is questionable.Key words: zinc, hemodialysis, trace elementsIntroductionFor human beings trace elements are essential nutri-ents with many important functions. They are indispens-able components of many enzymes, have some regulatoryfunctions and may affect immune reactions1,2. Zinc is co-factor for many metal enzymes (>90%), including redblood cells carboxyanhidrase, alkaline phosphatase andenzymes involved in RNA and DNA synthesis (polymer-ase). It is necessary for growth and cells' division. Espe-cially fast-dividing cells in immune system (lymphocytes)are sensitive to zinc deficiency. Zinc is found in red bloodcells in 75–88%. In the serum, zinc is completely boundto proteins, 60–70% on albumin, the rest on alfa2-macro-globulin and transferine. Serum concentrations are de-pendent on daily variations, and abnormalities are relatedto renal failure, gastrointestinal diseases and alcoholism.The role of trace elements in hemodialysis (HD) pa-tients has not yet been fully characterized. Abnormal-ities of trace elements are primarily result of uremia3,4,but they may be further modified by the dialysis pro-cedure5. To prevent complications in chronic HD pa-tients, it is very important to know and regulate the lev-els of trace elements.Zinc deficiency may be present in chronic renal fai-lure6. It has been associated with anorexia, diarrhea, neg-ative nitrogen balance, acrodermatitis, and impotency.Reports indicate that dysgeusia and impotency may beimproved by giving zinc supplements to the patients.Zinc deficiency seems to be correlated with some signs ofmalnutrition in HD patients7. Moreover, a recent ran-domized study in maintenance dialysis patients has shownthat the daily intake of a 2.2 mg zinc sulfate supplementwas able to correct serum zinc levels to normal values,and this was associated with an increase in normalizedprotein nitrogen appearance (nPNA)8. Recent studiesshowed that zinc supplementation also correct the cho-lesterol level which is often low and is the sign of the mal-nutrition in HD patients9.During HD, elimination of substances is dependentupon concentration gradient between blood and dialysisfluid, hydrophilic characteristics of the substance, bind-ing to proteins, and molecular weight. Alterations of zincconcentrations in serum of dialyzed patients have beenpreviously investigated3,10–12. The purpose of this studywas to assess the zinc serum concentrations in patientswith end-stage renal disease on maintenance HD.125Received for publication December 23, 2004Materials and MethodsEighty-nine HD patients were enrolled. Demographicpatient's characteristics and dialysis data are shown in ta-ble 1. Blood samples were collected before and after HDsessions.Serum concentrations of electrolytes (sodium and po-tassium) were routinely measured before and after HDby phlame photometry on IL 943 (Instrumentation Labo-ratory, USA). Additionally, we measured urea and crea-tinine concentrations as well as concentrations of cal-cium, phosphorus and glucose using conventional me-thods on Hitachi 704 autoanalyzer (Roche, Germany).Zinc determination is based on the fact that zincforms a red chelate complex with 2-(5-brom-2-pyridy-lazo)-5-(N-propyl-N-sulfopropylamino)-phenol. The in-crease of absorbance was measured on Opton spectro-photometer and was proportional to the concentration oftotal zinc13.In all laboratory test determinations, commercial qu-ality control samples were used as recommended.Data were analyzed using the Sigma Plot ScientificGraphing System, Version 6.10. Nonparametric test wasperformed using Mann-Whitney U-test. The differenceswere considered significant for p<0.05. Results are shownas mean value ± standard deviation.ResultsConcentration changes of urea, creatinine, phospho-rus, potassium and calcium in patients after HD weresignificant, as expected (Table 2). In all patients concen-trations of urea, creatinine, phosphorus and potassiumdecreased for 50% or even more (p<0.001). HD influ-enced calcium concentration increasing its values, insome patients for up to 136% (p<0.001). Glucose and so-[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–129126TABLE 1DEMOGRAPHIC CHARACTERISTICS OF THE PATIENT’SCharacteristic Value (%)Gender:Male 41 (46%)Female 48 (54%)Mean patient’s age (years)* 63±11Mean dialysis duration (years)* 4.98±3.39Mean ultrafiltration rate in all treatments* 2.6±3.4Type of dialysis membrane:cellulose diacetate 44 (49%)Polysulfone 45 (51%)Type of dialysis:low-flux procedure (hemodialysis) 66 (74%)high-flux procedure (hemodiafiltration) 23 (26%)mean dialysis delivered dose (Kt/V) * 1.21±0.15Underlying renal disease:diabetic nephropathy 25 (28%)glomerulonephritis 22 (25%)vascular disease 14 (16%)pyelonephritis 9 (10%)polycystic kidney disease 8 (9%)interstitial nephritis 7 (8%)other 4 (4%)* X±SDTABLE 2SERUM CONCENTRATIONS OF ZINC, CALCIUM, PHOSPHORUS, SODIUM, POTASSIUM, UREA, CREATININE AND GLUCOSE BEFOREAND AFTER HEMODIALYSIS (N=89)UnitReferencerangeBefore hemodialysis(X±SD)After hemodialysis(X±SD)pZinc mol/L 10.7–19.5 16.3±7.7 14.2±2.9 nsCalcium mmol/L 2.0–2.6 2.3±0.3 2.9±0.2 <0.001Phosphorus mmol/L 1.0–1.6 2.2±0.6 1.2±0.2 <0.001Sodium mmol/L 133–147 138±4 138±3 nsPotassium mmol/L 3.8–5.1 5.4±0.7 3.8±0.4 <0.001Urea mmol/L to 7.5 26.8±7.4 8.4±3.6 <0.001Creatinine mol/L to 110 722±150 288±81 <0.001Glucose mmol/L to 6.1 6.1±3.1 6.9±2.9 nsFig. 1. Serum zinc concentrations in patients before hemodialysis.Percentage of patients with normal, elevated or low zinc concen-trations.dium concentrations did not change. Zinc concentrationsshowed to be dependent on HD. Before HD, 50 patients(56%) had normal, 15 (17%) low, and 24 (27%) elevatedserum zinc concentrations (Figure 1). In 57 (64%) pa-tients zinc decreased from higher values (up to 42 mol/L)to the final one that remained within normal range (upto 10.7 mol/L). In remained 32 (36%) patients, zinc con-centrations increased (up to 19.5 mol/ L), but remainedwithin normal range (Figures 2, 3). We compared zincvalues and nutritional parameters in HD patients (Table3).DiscussionIt is well known that patients on chronic HD are athigh risk of developing trace element imbalances11,14,which can further induce different abnormalities in thispatients15–17. Such abnormalities of zinc metabolism andalterations in serum zinc concentrations have been re-[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–1291270510152025303540451 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88Patient sampleZincconcentration(umol/L) Before HDAfter HDReferenceFig. 2. Alterations in serum zinc concentrations before and after hemodialysis (HD).Fig. 3. Changes in zinc concentration after hemodialysis dependingon elevated, low or normal concentration before hemodialysis (HD).X – axis represents the groups of patients according to serum zincconcentrations and total patients sample.TABLE 3COMPARISON OF ZINC VALUES AND NUTRITIONAL PARAMETERS IN HAEMODIALYSIS PATIENTS (X±SD)Nutritional parameterZinc<11.5 mol/L(N=19)11.5-18.5 mol/L(N=43)>18.5 mol/L(N=27)p*Body Mass Index 24±4 24±4 24±5 nsSerum albumin (g/L) 38±6 39±5 38±5 nsC-reactive protein 9.3±6 8.7±5 9.7±5 nsCholesterol (mmol/L) 5.5±1.9 5.5±1.9 5.1±17 nsSerum creatinine (mol/L) 886±120 792±202 833±177 nsProtein catabolic rate 0.55±0.05 0.55±0.05 0.57±0.07 ns*Mann-Whitney U testported10,12. Most of authors reported low zinc concentra-tions in serum of patients undergoing HD. Lee at al.18have found that 78% of patients on HD had low plasmazinc concentrations and Castro at al.19 reported thatabout 20% of such patients were hypozincemic. Krachleret al.11 found that plasma concentrations of zinc continu-ously increase during HD, but always stay at or below thereference range. Low plasma zinc concentrations tendingto increase with HD duration were found by Skarupski-ene et al.5. Striking was the report of Prehn3 that serumzinc level increases after treatment using the hemo-dialysis membrane KN 401. He also reported benefit ofHD on zinc status in these patients. He found that serumlevel of zinc is reduced with the progression of chronic re-nal failure, but also pointed out that in advanced renalfailure hypozincemia is more pronounced with conserva-tive therapy than in the patients on regular HD.Our results strongly suggest that serum concentra-tions of zinc are normalized after the HD treatment. Inthe present study, serum samples from 89 patients withend-stage renal failure treated by regular HD were with-drawn for the estimation of zinc concentrations immedi-ately before and after dialysis. Before HD 24 patients(27%) had elevated and 15 patients (17%) had low serumzinc concentrations, regarding the reference range foradult healthy persons (Figure 1). After HD all the resultsof serum zinc concentrations were within reference ran-ge (Figure 2).Further, we found no correlations between zinc val-ues and nutritional parameters in HD patients (Table 3).There are many factors that can influence serum zincconcentrations. Bogden et al.19 reported that certain dis-posable dialytic coils are contaminated with zinc and re-lease substantial quantities of zinc during HD, producinghigh post-dialysis plasma concentrations. Low plasmazinc level was more often found in patients with <12hour/week of HD duration and <12 months of HD treat-ment (5). At the same time, Castro et al.20 concluded thatthe occurrence of hypozincemia was not related to dialy-sis modality and that zincemia did not reflect low dietaryintake of zinc. Still, efficiency of HD and water treatmentmay play an important role, because increased zinc levelin serum after HD can be the consequence of reducing to-tal blood volume in these patients. It was shown that ex-cept for aluminum, blood levels of trace metals in HD pa-tients were not related to their medication18, but thatenvironmental factors, diet, and the aging process maycontribute to the trace metal burden in uremia. Even inthe case of zinc supplementation, plasma zinc levels werenot changed, according to findings of Richard et al.21.Alterations of serum zinc during HD are still unclearand are probably affected by individual patient's metabo-lism and specific illness. Future studies have to addressmore specific parameters, e.g. alterations in serum pro-teins, enzymes and antioxidants, specific conditions likeosteoporosis, as well as patient's age, duration of HD andmedication. In the meantime, although serum concentra-tion of zinc do not reflect the real body status of thistrace element, it can be easily determined in routinepractice and may give a quick insight and warning aboutpossible disorders of zinc metabolism.R E F E R E N C E S1. FERENCIK, M., L. EBRINGER, Folia Microbiol. (Praha), 48 (2003)417. — 2. MASEK, K., J. SLANSKY, P. PETROVICKY, J. W. HADDEN,Int. Immunopharmacol., 3 (2003) 1235. — 3. PREHN, B., Z., Urol. Neph-rol., 81 (1988) 35. — 4. MAFRA, D., L. CUPPARI, S. M. COZZOLINO, J.Ren. Nutr., 12 (2002) 38. — 5. SKARUPSKIENE, I., V. KUZMINSKIS, O.ABDRACHMANOVAS, S. RYSELIS, A. SMALINSKIENE, R. NAGINI-ENE, A. LAUKEVICIUS, Medicina (Kaunas), 39 Suppl. 1 (2003) 131. — 6.SPRENGER, K. G., D. BUNDSCHU, K. LEWIS, B. SPOHN, J. SCHMITZ,P. FRANZ, Kidney. Int., 24 (1983) 315. — 7. LOCATELLI, F., D. FOU-QUE, O. HEIMBURGER, T. B. DRÜEKE, J. B. CANNATA-ANDÍA, W. H.HÖRL, E. RITZ, Nephrol. Dial. Transplant., 17 (2002) 563. — 8. JERN,N. A., A. D. VANBEBER, M. A. GORMAN, C. G. WEBER, G. U. LIEPA, C.C. COCHRAN, J. Ren. Nutr., 10 (2000) 148. — 9. CHEVALIER, C. A., G.LIEPA, M. D. MURPHY, J. SUNESON, A. D. VANBEBER, M. A. GOR-MAN, C. C. COCHRAN, J. Ren. Nutr., 12 (2002) 183. — 10. SENFT, V., M.KRIZEK, J. MOTAN, J. RACEK, Cas. Lek. Cesk., 138 (1999) 245. — 11.KRACHLER, M., H. SCHARFETTER, G. H. WIRNSBERGER, Clin.Nephrol., 54 (2000) 35. — 12. PIETRZAK, I., K. BLADEK, W. BULIKOW-SKI, Magnes. Res., 15 (2002) 229. — 13. JOHNSEN, O., R. ELIASSON,Int. J. Androl., 10 (1987) 435. — 14. ZIMA, T., O. MESTEK, K. NEMEC-EK, V. BARTOVA, J. FIALOVA, V. TESAR, M. SUCHANEK, Blood Purif.,16 (1998) 253. — 15. D'HAESE, P. C., M. M. COUTTENYE, L. V. LAM-BERTS, M. M. ELSEVIERS, W. G. GOODMAN, I. SCHROOTEN, W. E.CABRERA, M. E. DE BROE, Clin. Chem., 45 (1999) 1548. — 16. KREFT,B., A. FISCHER, S. KRUGER, K. SACK, H. KIRCHNER, L. RINK, Bio-gerontology, 1 (2000) 61. — 17. MATSON, A., M. WRIGHT, A. OLIVER,G. WOODROW, N. KING, L. DYE, J. BLUNDELL, A. BROWNJOHN, J.TURNEY, J. Ren. Nutr., 13 (2003) 224. — 18. LEE, S. H., J. W. HUANG,K. Y. HUNG, L. J. LEU, Y. T. KAN, C. S. YANG, D. CHUNG WU, C. L.HUANG, P. Y. CHEN, J. S. CHEN, W. Y. CHEN, Artif. Organs, 24 (2000)841. — 19. BOGDEN, J. D., E. ZADZIELSKI, B. WEINER, J. M. OLES-KE, A. AVIV, Am. J. Clin. Nutr., 36 (1982) 403. — 20. CASTRO, A. V., J.CARAMORI, P. BARRETTI, E. E. BAPTISTELLI, A. BRANDAO, E. M.BARIM, C. R. PADOVANI, F. F. ARAGON, J. BRANDAO-NETO, Biol.Trace Elem. Res., 88 (2002) 1. — 21. RICHARD, M. J., V. DUCROS, M.FORET, J. ARNAUD, C. COUDRAY, M. FUSSELIER, A. FAVIER, Biol.Trace Elem. Res., 39 (1993) 149.[. DvornikDepartment of Laboratory Diagnostics, University Hospital Center Rijeka, T. Stri`i}a 3, 51000 Rijeka, Croatiae-mail: sanjin.racki@ri.t-com.hr[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–129128KONCENTRACIJA CINKA U SERUMU U BOLESNIKA NA REDOVITOJ HEMODIJALIZIS A @ E T A KCink je neophodan element za rast stanica, njegov manjak mo`e bitno utjecati na antioksidativni obrambeni sustav,obi~no u svezi sa kroni~nom bolesti bubrega, bolestima probavnog trakta i kroni~nim alkoholizmom. U bolesnika nadijalizi zna~ajno je znati koncentraciju cinka, te sprije~iti hipo i hipercinkemiju. Analizirali smo 89 uzoraka krvi bo-lesnika sa terminalnim zatajenjem bubrega na redovitoj hemodijalizi. Odre|ene su koncentracije cinka prije i poslijepostupka hemodijalize. Rezultati su pokazali da su koncentracije cinka bile ovisne o postupku hemodijalize. U 57 (64%)bolesnika, koncentracija cinka u serumu sni`ena je postupkom hemodijalize, ponekad od vrlo visokih do normalnihvrijednosti. U preostalih 32 (36%) bolesnika, koncentracija cinka je porasla nakon postupka hemodijalize, ali su vri-jednosti ostale u normalnim granicama. Suplementi cinka su preporu~ljivi samo u bolesnika sa dokazanom deficijen-cijom cinka, ali u je upitna njihova primjena u svih bolesnika sa kroni~nim bubre`nim zatajenjem.[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–129129

Serum Zinc Concentrations in the Maintenance Hemodialysis Patients

Dvornik, Štefica

Ćuk, Mira

Rački, Sanjin

Zaputović, Luka

Repository of the University of Rijeka

Coll. Antropol. 30 (2006) 1: 125–129Original scientific paperSerum Zinc Concentrations in the MaintenanceHemodialysis Patients[tefica Dvornik1, Mira ]uk2, Sanjin Ra~ki3 and Luka Zaputovi}31 Department of Laboratory Diagnostics, University Hospital Center Rijeka, Rijeka, Croatia2 Department of Physiology and Immunology, School of Medicine, University of Rijeka, Rijeka, Croatia3 Department of Internal Medicine, University Hospital Center Rijeka, Rijeka, CroatiaA B S T R A C TZinc is necessary for growth and cells' division. Its deficiency may seriously affect antioxidant defense system and isusually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dia-lyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failureon regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis.Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentra-tions decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrationstended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patientswith proven zinc deficiency, but for all chronic renal failure patients it is questionable.Key words: zinc, hemodialysis, trace elementsIntroductionFor human beings trace elements are essential nutri-ents with many important functions. They are indispens-able components of many enzymes, have some regulatoryfunctions and may affect immune reactions1,2. Zinc is co-factor for many metal enzymes (>90%), including redblood cells carboxyanhidrase, alkaline phosphatase andenzymes involved in RNA and DNA synthesis (polymer-ase). It is necessary for growth and cells' division. Espe-cially fast-dividing cells in immune system (lymphocytes)are sensitive to zinc deficiency. Zinc is found in red bloodcells in 75–88%. In the serum, zinc is completely boundto proteins, 60–70% on albumin, the rest on alfa2-macro-globulin and transferine. Serum concentrations are de-pendent on daily variations, and abnormalities are relatedto renal failure, gastrointestinal diseases and alcoholism.The role of trace elements in hemodialysis (HD) pa-tients has not yet been fully characterized. Abnormal-ities of trace elements are primarily result of uremia3,4,but they may be further modified by the dialysis pro-cedure5. To prevent complications in chronic HD pa-tients, it is very important to know and regulate the lev-els of trace elements.Zinc deficiency may be present in chronic renal fai-lure6. It has been associatedwith anorexia, diarrhea, neg-ative nitrogen balance, acrodermatitis, and impotency.Reports indicate that dysgeusia and impotency may beimproved by giving zinc supplements to the patients.Zinc deficiency seems to be correlated with some signs ofmalnutrition in HD patients7. Moreover, a recent ran-domized study in maintenance dialysis patients has shownthat the daily intake of a 2.2 mg zinc sulfate supplementwas able to correct serum zinc levels to normal values,and this was associated with an increase in normalizedprotein nitrogen appearance (nPNA)8. Recent studiesshowed that zinc supplementation also correct the cho-lesterol level which is often low and is the sign of the mal-nutrition in HD patients9.During HD, elimination of substances is dependentupon concentration gradient between blood and dialysisfluid, hydrophilic characteristics of the substance, bind-ing to proteins, and molecular weight. Alterations of zincconcentrations in serum of dialyzed patients have beenpreviously investigated3,10–12. The purpose of this studywas to assess the zinc serum concentrations in patientswith end-stage renal disease on maintenance HD.125Received for publication December 23, 2004Materials and MethodsEighty-nine HD patients were enrolled. Demographicpatient's characteristics and dialysis data are shown in ta-ble 1. Blood samples were collected before and after HDsessions.Serum concentrations of electrolytes (sodium and po-tassium) were routinely measured before and after HDby phlame photometry on IL 943 (Instrumentation Labo-ratory, USA). Additionally, we measured urea and crea-tinine concentrations as well as concentrations of cal-cium, phosphorus and glucose using conventional me-thods on Hitachi 704 autoanalyzer (Roche, Germany).Zinc determination is based on the fact that zincforms a red chelate complex with 2-(5-brom-2-pyridy-lazo)-5-(N-propyl-N-sulfopropylamino)-phenol. The in-crease of absorbance was measured on Opton spectro-photometer and was proportional to the concentration oftotal zinc13.In all laboratory test determinations, commercial qu-ality control samples were used as recommended.Data were analyzed using the Sigma Plot ScientificGraphing System, Version 6.10. Nonparametric test wasperformed using Mann-Whitney U-test. The differenceswere considered significant for p<0.05. Results are shownas mean value ± standard deviation.ResultsConcentration changes of urea, creatinine, phospho-rus, potassium and calcium in patients after HD weresignificant, as expected (Table 2). In all patients concen-trations of urea, creatinine, phosphorus and potassiumdecreased for 50% or even more (p<0.001). HD influ-enced calcium concentration increasing its values, insome patients for up to 136% (p<0.001). Glucose and so-[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–129126TABLE 1DEMOGRAPHIC CHARACTERISTICS OF THE PATIENT’SCharacteristic Value (%)Gender:Male 41 (46%)Female 48 (54%)Mean patient’s age (years)* 63±11Mean dialysis duration (years)* 4.98±3.39Mean ultrafiltration rate in all treatments* 2.6±3.4Type of dialysis membrane:cellulose diacetate 44 (49%)Polysulfone 45 (51%)Type of dialysis:low-flux procedure (hemodialysis) 66 (74%)high-flux procedure (hemodiafiltration) 23 (26%)mean dialysis delivered dose (Kt/V) * 1.21±0.15Underlying renal disease:diabetic nephropathy 25 (28%)glomerulonephritis 22 (25%)vascular disease 14 (16%)pyelonephritis 9 (10%)polycystic kidney disease 8 (9%)interstitial nephritis 7 (8%)other 4 (4%)* X±SDTABLE 2SERUM CONCENTRATIONS OF ZINC, CALCIUM, PHOSPHORUS, SODIUM, POTASSIUM, UREA, CREATININE AND GLUCOSE BEFOREAND AFTER HEMODIALYSIS (N=89)UnitReferencerangeBefore hemodialysis(X±SD)After hemodialysis(X±SD)pZincmol/L 10.7–19.5 16.3±7.7 14.2±2.9 nsCalcium mmol/L 2.0–2.6 2.3±0.3 2.9±0.2 <0.001Phosphorus mmol/L 1.0–1.6 2.2±0.6 1.2±0.2 <0.001Sodium mmol/L 133–147 138±4 138±3 nsPotassium mmol/L 3.8–5.1 5.4±0.7 3.8±0.4 <0.001Urea mmol/L to 7.5 26.8±7.4 8.4±3.6 <0.001Creatininemol/L to 110 722±150 288±81 <0.001Glucose mmol/L to 6.1 6.1±3.1 6.9±2.9 nsFig. 1. Serum zinc concentrations in patients before hemodialysis.Percentage of patients with normal, elevated or low zinc concen-trations.dium concentrations did not change. Zinc concentrationsshowed to be dependent on HD. Before HD, 50 patients(56%) had normal, 15 (17%) low, and 24 (27%) elevatedserum zinc concentrations (Figure 1). In 57 (64%) pa-tients zinc decreased from higher values (up to 42 mol/L)to the final one that remained within normal range (upto 10.7 mol/L). In remained 32 (36%) patients, zinc con-centrations increased (up to 19.5 mol/ L), but remainedwithin normal range (Figures 2, 3). We compared zincvalues and nutritional parameters in HD patients (Table3).DiscussionIt is well known that patients on chronic HD are athigh risk of developing trace element imbalances11,14,which can further induce different abnormalities in thispatients15–17. Such abnormalities of zinc metabolism andalterations in serum zinc concentrations have been re-[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–1291270510152025303540451 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88Patient sampleZincconcentration(umol/L) Before HDAfter HDReferenceFig. 2. Alterations in serum zinc concentrations before and after hemodialysis (HD).Fig. 3. Changes in zinc concentration after hemodialysis dependingon elevated, low or normal concentration before hemodialysis (HD).X – axis represents the groups of patients according to serum zincconcentrations and total patients sample.TABLE 3COMPARISON OF ZINC VALUES AND NUTRITIONAL PARAMETERS IN HAEMODIALYSIS PATIENTS (X±SD)Nutritional parameterZinc<11.5 mol/L(N=19)11.5-18.5 mol/L(N=43)>18.5 mol/L(N=27)p*Body Mass Index 24±4 24±4 24±5 nsSerum albumin (g/L) 38±6 39±5 38±5 nsC-reactive protein 9.3±6 8.7±5 9.7±5 nsCholesterol (mmol/L) 5.5±1.9 5.5±1.9 5.1±17 nsSerum creatinine (mol/L) 886±120 792±202 833±177 nsProtein catabolic rate 0.55±0.05 0.55±0.05 0.57±0.07 ns*Mann-Whitney U testported10,12. Most of authors reported low zinc concentra-tions in serum of patients undergoing HD. Lee at al.18have found that 78% of patients on HD had low plasmazinc concentrations and Castro at al.19 reported thatabout 20% of such patients were hypozincemic. Krachleret al.11 found that plasma concentrations of zinc continu-ously increase during HD, but always stay at or below thereference range. Low plasma zinc concentrations tendingto increase with HD duration were found by Skarupski-ene et al.5. Striking was the report of Prehn3 that serumzinc level increases after treatment using the hemo-dialysis membrane KN 401. He also reported benefit ofHD on zinc status in these patients. He found that serumlevel of zinc is reduced with the progression of chronic re-nal failure, but also pointed out that in advanced renalfailure hypozincemia is more pronounced with conserva-tive therapy than in the patients on regular HD.Our results strongly suggest that serum concentra-tions of zinc are normalized after the HD treatment. Inthe present study, serum samples from 89 patients withend-stage renal failure treated by regular HD were with-drawn for the estimation of zinc concentrations immedi-ately before and after dialysis. Before HD 24 patients(27%) had elevated and 15 patients (17%) had low serumzinc concentrations, regarding the reference range foradult healthy persons (Figure 1). After HD all the resultsof serum zinc concentrations were within reference ran-ge (Figure 2).Further, we found no correlations between zinc val-ues and nutritional parameters in HD patients (Table 3).There are many factors that can influence serum zincconcentrations. Bogden et al.19 reported that certain dis-posable dialytic coils are contaminated with zinc and re-lease substantial quantities of zinc during HD, producinghigh post-dialysis plasma concentrations. Low plasmazinc level was more often found in patients with <12hour/week of HD duration and <12 months of HD treat-ment (5). At the same time, Castro et al.20 concluded thatthe occurrence of hypozincemia was not related to dialy-sis modality and that zincemia did not reflect low dietaryintake of zinc. Still, efficiency of HD and water treatmentmay play an important role, because increased zinc levelin serum after HD can be the consequence of reducing to-tal blood volume in these patients. It was shown that ex-cept for aluminum, blood levels of trace metals in HD pa-tients were not related to their medication18, but thatenvironmental factors, diet, and the aging process maycontribute to the trace metal burden in uremia. Even inthe case of zinc supplementation, plasma zinc levels werenot changed, according to findings of Richard et al.21.Alterations of serum zinc during HD are still unclearand are probably affected by individual patient's metabo-lism and specific illness. Future studies have to addressmore specific parameters, e.g. alterations in serum pro-teins, enzymes and antioxidants, specific conditions likeosteoporosis, as well as patient's age, duration of HD andmedication. In the meantime, although serum concentra-tion of zinc do not reflect the real body status of thistrace element, it can be easily determined in routinepractice and may give a quick insight and warning aboutpossible disorders of zinc metabolism.R E F E R E N C E S1. FERENCIK, M., L. EBRINGER, Folia Microbiol. (Praha), 48 (2003)417. — 2. MASEK, K., J. SLANSKY, P. PETROVICKY, J. W. HADDEN,Int. Immunopharmacol., 3 (2003) 1235. — 3. PREHN, B., Z., Urol. Neph-rol., 81 (1988) 35. — 4. MAFRA, D., L. CUPPARI, S. M. COZZOLINO, J.Ren. Nutr., 12 (2002) 38. — 5. SKARUPSKIENE, I., V. KUZMINSKIS, O.ABDRACHMANOVAS, S. RYSELIS, A. SMALINSKIENE, R. NAGINI-ENE, A. LAUKEVICIUS, Medicina (Kaunas), 39 Suppl. 1 (2003) 131. — 6.SPRENGER, K. G., D. BUNDSCHU, K. LEWIS, B. SPOHN, J. SCHMITZ,P. FRANZ, Kidney. Int., 24 (1983) 315. — 7. LOCATELLI, F., D. FOU-QUE, O. HEIMBURGER, T. B. DRÜEKE, J. B. CANNATA-ANDÍA, W. H.HÖRL, E. RITZ, Nephrol. Dial. Transplant., 17 (2002) 563. — 8. JERN,N. A., A. D. VANBEBER, M. A. GORMAN, C. G. WEBER, G. U. LIEPA, C.C. COCHRAN, J. Ren. Nutr., 10 (2000) 148. — 9. CHEVALIER, C. A., G.LIEPA, M. D. MURPHY, J. SUNESON, A. D. VANBEBER, M. A. GOR-MAN, C. C. COCHRAN, J. Ren. Nutr., 12 (2002) 183. — 10. SENFT, V., M.KRIZEK, J. MOTAN, J. RACEK, Cas. Lek. Cesk., 138 (1999) 245. — 11.KRACHLER, M., H. SCHARFETTER, G. H. WIRNSBERGER, Clin.Nephrol., 54 (2000) 35. — 12. PIETRZAK, I., K. BLADEK, W. BULIKOW-SKI, Magnes. Res., 15 (2002) 229. — 13. JOHNSEN, O., R. ELIASSON,Int. J. Androl., 10 (1987) 435. — 14. ZIMA, T., O. MESTEK, K. NEMEC-EK, V. BARTOVA, J. FIALOVA, V. TESAR, M. SUCHANEK, Blood Purif.,16 (1998) 253. — 15. D'HAESE, P. C., M. M. COUTTENYE, L. V. LAM-BERTS, M. M. ELSEVIERS, W. G. GOODMAN, I. SCHROOTEN, W. E.CABRERA, M. E. DE BROE, Clin. Chem., 45 (1999) 1548. — 16. KREFT,B., A. FISCHER, S. KRUGER, K. SACK, H. KIRCHNER, L. RINK, Bio-gerontology, 1 (2000) 61. — 17. MATSON, A., M. WRIGHT, A. OLIVER,G. WOODROW, N. KING, L. DYE, J. BLUNDELL, A. BROWNJOHN, J.TURNEY, J. Ren. Nutr., 13 (2003) 224. — 18. LEE, S. H., J. W. HUANG,K. Y. HUNG, L. J. LEU, Y. T. KAN, C. S. YANG, D. CHUNG WU, C. L.HUANG, P. Y. CHEN, J. S. CHEN, W. Y. CHEN, Artif. Organs, 24 (2000)841. — 19. BOGDEN, J. D., E. ZADZIELSKI, B. WEINER, J. M. OLES-KE, A. AVIV, Am. J. Clin. Nutr., 36 (1982) 403. — 20. CASTRO, A. V., J.CARAMORI, P. BARRETTI, E. E. BAPTISTELLI, A. BRANDAO, E. M.BARIM, C. R. PADOVANI, F. F. ARAGON, J. BRANDAO-NETO, Biol.Trace Elem. Res., 88 (2002) 1. — 21. RICHARD, M. J., V. DUCROS, M.FORET, J. ARNAUD, C. COUDRAY, M. FUSSELIER, A. FAVIER, Biol.Trace Elem. Res., 39 (1993) 149.[. DvornikDepartment of Laboratory Diagnostics, University Hospital Center Rijeka, T. Stri`i}a 3, 51000 Rijeka, Croatiae-mail: sanjin.racki@ri.t-com.hr[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–129128KONCENTRACIJA CINKA U SERUMU U BOLESNIKA NA REDOVITOJ HEMODIJALIZIS A @ E T A KCink je neophodan element za rast stanica, njegov manjak mo`e bitno utjecati na antioksidativni obrambeni sustav,obi~no u svezi sa kroni~nom bolesti bubrega, bolestima probavnog trakta i kroni~nim alkoholizmom. U bolesnika nadijalizi zna~ajno je znati koncentraciju cinka, te sprije~iti hipo i hipercinkemiju. Analizirali smo 89 uzoraka krvi bo-lesnika sa terminalnim zatajenjem bubrega na redovitoj hemodijalizi. Odre|ene su koncentracije cinka prije i poslijepostupka hemodijalize. Rezultati su pokazali da su koncentracije cinka bile ovisne o postupku hemodijalize. U 57 (64%)bolesnika, koncentracija cinka u serumu sni`ena je postupkom hemodijalize, ponekad od vrlo visokih do normalnihvrijednosti. U preostalih 32 (36%) bolesnika, koncentracija cinka je porasla nakon postupka hemodijalize, ali su vri-jednosti ostale u normalnim granicama. Suplementi cinka su preporu~ljivi samo u bolesnika sa dokazanom deficijen-cijom cinka, ali u je upitna njihova primjena u svih bolesnika sa kroni~nim bubre`nim zatajenjem.[. Dvornik et al.: Zinc in the Hemodialysis Patients, Coll. Antropol. 30 (2006) 1: 125–129129

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Serum Zinc Concentrations in the Maintenance Hemodialysis Patients

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