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Reply to Editor: Serum zinc levels in hemodialysis and peritoneal dialysis patients: A retrospective observational study
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Background
Zinc is vital for cellular functions, but kidney failure increases zinc deficiency risk. We compared zinc levels in hemodialysis (HD) and peritoneal dialysis (PD) patients in Isfahan, Iran.
Materials and Methods
A retrospective study included 150 patients (75 PD and 75 HD). Serum zinc levels were assessed through photometry. Statistical analysis employed Chi-square, independent t -test, and correlation.
Results
Serum zinc was below normal in both groups ( P < 0.01). HD patients had lower zinc levels (70.85 ± 7.68 mg/dL) compared to PD (75.04 ± 13.55 mg/dL, P = 0.021), remaining significant after adjusting for confounders ( P = 0.011).
Conclusion
Zinc levels in PD and HD patients are lower than in the general population, with HD patients having lower levels than PD patients.
Background: Heart failure (HF) is a clinical disorder and Zinc is an important cofactor in regulating oxidative status. The present study aimed to determine the mean concentration of serum zinc in patients with HF. Methods: PubMed, Embase, Scopus, and Web of Science were used in the present systematic review and meta-analysis to find relevant cross-sectional studies up to 1 st January 2020. A random-effects model was used to pool the effect size (ES) and 95% confidence intervals (CI). In addition, meta-regression analysis was performed to find the sources of statistical heterogeneity among the studies. Results: Our meta-analysis of 1358 HF patients indicated that their mean serum zinc concentration was 66.24 µg/dl (95% CI: 59.16, 73.33). In sub-analysis, the mean concentration was 75.04 µg/dl and 52.90 µg/dl in patients <65 years and >65 years old, respectively. Subgroup analysis by geographical region showed that mean serum zinc was 70.70 µg/dl, 69.08 µg/dl and 60.91 µg/ dl in HF patients from Europe, America, and Asia, respectively. Meta-regression analysis indicated a reduction of 1.42 µg/dl in serum zinc per each year of aging. Conclusion: In summary, our meta-analysis indicates that serum zinc concentrations have a narrow range in HF patients worldwide that declines with age and varies with geographical region. Additionally, serum zinc concentrations are lower in HF patients, specifically in the elderly. Please cite this article as: Jalali M, Symonds ME, Zare M, Sohrabi Z. Reference Range of Serum Zinc Concentration in Patients with Heart Failure: A Systematic Review and Meta-analysis of Cross-Sectional Studies in the 21 st Century. J Health Sci Surveillance Sys. 2022;10(2):150-157.
We examined the effects of zinc supplementation on serum zinc and C-reactive protein concentrations in hemodialysis patients.
This was a randomized, double-blinded, placebo-controlled clinical trial.
This study was conducted at the Shahid Faghihi and Namazi Dialysis Centers in Shiraz, Iran.
Fifty-five hemodialysis patients (32 men and 23 women) participated after meeting the following criteria: zinc deficiency, treated for a minimum of 6 months; no record of hospitalizations in the preceding 3 months; and hemodialysis treatment 2 to 3 times per week.
Patients were randomly divided into two groups. The zinc supplementation group (n=28) received a 220-mg zinc sulfate capsule, and the control group (n=27) received a placebo capsule (220 mg corn starch), for 42 days.
Fasting, predialysis serum samples were collected on days 0 and 42 to determine serum zinc and C-reactive protein levels.
After supplementation, subjects in the zinc-supplemented group showed significant increases in serum zinc concentrations, from 57.4+/-2.4 microg/dL SEM on day 0 to 88.4+/-4.8 microg/dL SEM on day 42. Serum C-reactive protein concentrations were initially high among subjects in the control (15.1+/-3.9 mg/L SEM) and zinc-supplemented (13.5+/-3.8 mg/L SEM) groups. Serum C-reactive protein concentrations in the control group increased throughout the study period, but did not reach statistical significance. A progressive decrease in serum C-reactive protein concentrations was observed in the zinc-supplemented group from the beginning (13.5+/-3.8mg/L SEM) to the end (10.5+/-3.5mg/L SEM) of the study, but this event was not significant.
Zinc supplementation intake may cause an increase in serum zinc concentrations, leading to a decrease of inflammation in hemodialysis patients.
Background:
Serum zinc concentration is used to assess the zinc status of populations. Cutoffs for serum zinc were developed on the basis of data from the second NHANES (1976-1980).
Objective:
The objective of this study was to evaluate serum zinc concentrations in the US population and to determine factors affecting serum zinc with the use of NHANES 2011-2014.
Methods:
Serum zinc was determined in males and females aged ≥6 y with the use of NHANES 2011-2014 (n = 4347). Dietary zinc intake was determined, and factors affecting serum zinc were identified with the use of regression models adjusting for sex, age, fasting status, and time of blood draw. ORs were calculated to identify factors associated with the risk of being below the serum zinc cutoff, and the prevalence of low serum zinc in the US was calculated. P < 0.01 was considered significant.
Results:
Mean ± SE serum zinc concentration in males and females was 84.9 ± 0.8 and 80.6 ± 0.6, respectively (P < 0.0001). Regression models with serum zinc as the dependent variable indicated that afternoon and evening blood draws (β = -9.7 and -15.3; P < 0.0001) were negatively associated with serum zinc concentrations and serum albumin (β = 16.1; P < 0.0001) and hemoglobin (β = 1.0; P = 0.0048) were positively associated with serum zinc concentrations. Hypoalbuminemia (OR = 11.2; 99% CI: 3.4, 37.3), anemia in females (OR: 3.4; 99% CI: 1.7, 6.9), and pregnancy (OR: 9.6; 99% CI: 2.9, 31.9) increased the odds of being below the serum zinc cutoff (P < 0.0001 for all). Zinc from diet or supplements did not affect serum zinc (P > 0.01). Approximately 3.8% of children (<10 y), 8.6% of males (≥10 y), and 8.2% of females (≥10 y) were below the serum zinc cutoff.
Conclusions:
Factors such as sex, age, and time of blood draw should be considered when using serum zinc concentration to determine the zinc status of a population. Caution is advised when interpreting serum zinc concentration in populations with a high prevalence of hypoalbuminemia or anemia. This trial was registered at http://www.isrctn.com as ISRCTN96013840.
Serum zinc was measured in 126 fit healthy subjects living at home, 31 elderly males (mean age 78.3 years), 30 young males (mean age 21.6 years), 33 elderly females (mean age 81.6 years) and 32 young females (mean age 22.1 years). There were highly significant differences for serum zinc between the four groups with respect to age and sex (p<0.0002). Mean serum zinc was significantly lower in the elderly male group compared to the young male group with a similar but non significant trend in female groups. Males, old and young, had higher serum zinc levels than females of the same age and differences were significant between young males and females. Serum zinc levels are therefore lower in very elderly subjects compared to young subjects irrespective of sex, in keeping with findings noted in <75 year olds. Sex differences in serum zinc persist even in very old age, with elderly males showing higher levels than females of the same age.
Alterations in blood and tissue concentrations of trace elements in patients with chronic renal failure have been extensively investigated. Selenium, zinc and copper are elements which play an important role in biological systems as components of proteins, enzymes and antioxidants. The concentrations of selenium, zinc and copper were determined in the plasma, erythrocytes and whole blood of patients on regular hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) treatment using the method of inductively coupled plasma mass spectrometry (ICP-MS). Analysis of isotopes 77Se, 66Zn and 65Cu was performed. Methodology presents the major limitation to valid studies on trace element levels in biological materials. One of the widely used contemporary techniques is ICP-MS. It is the most sensitive one and has a high dynamic range. The selenium concentration in the studied compartments (plasma 46.1 ± 3.0 vs. 78.0 ± 3.4 μg/l, p < 0.001; erythrocytes 90.4 ± 6.5 vs. 134.2 ± 7.6 μg/l, p < 0.01; whole blood 67.3 ± 3.1 vs. 106.4 ± 3.4 μg/l, p < 0.001) was significantly lower in HD patients compared to healthy controls. The same result was observed in plasma (63.2 ± 5.8 vs. 78.0 ± 3.4 μg/l, p < 0.05) and whole blood (82.7 ± 7.4 vs. 106.4 ± 3.4 μg/l, p < 0.01) from CAPD patients, but the selenium level of erythrocytes in CAPD patients was the same as in the control group (126.0 ± 8.8 vs. 134.2 ± 7.6 μg/l). The cooper content of erythrocytes was lower in HD patients than in controls (0.55 ± 0.02 vs. 0.66 ± 0.01 mg/l, p < 0.01) and CAPD groups (0.55 ± 0.02 vs. 0.68 ± 0.02 mg/l, p < 0.001). There were no differences in copper content in plasma (HD 1.02 ± 0.06; CAPD 1.11 ± 0.09; controls 1.02 ± 0.05 mg/l) and whole blood (HD 0.87 ± 0.04; CAPD 0.90 ± 0.05; controls 0.85 ± 0.02 mg/l) in HD and CAPD patients and healthy controls. The zinc concentration was increased in the whole blood of CAPD patients (6.68 ± 0.36 vs. 5.52 ± 0.11 mg/l, p < 0.001) and erythrocytes of HD (12.30 ± 0.23 vs. 10.11 ± 0.42 mg/l, p < 0.001), and CAPD groups (13.71 ± 0.56 vs. 10.11 ± 0.42 mg/l, p < 0.001) compared to controls. However, the plasma zinc concentration was lower in HD patients compared to blood donors (0.69 ± 0.03 vs. 0.92 ± 0.03 mg/l, p < 0.001) and CAPD patients (0.69 ± 0.03 vs. 0.95 ± 0.04 mg/l, p < 0.001). We did not find a significant increase in trace elements in whole blood after HD. These results suggest differences between plasma, erythrocytes and whole blood concentrations of the studied trace elements. The levels of trace elements are altered by HD and CAPD. A modern precise method with high accuracy, ICP-MS, which was used in our study, eliminated analytical errors and possible interferences.
