Effects of zinc supplementation on serum copper to zinc and CRP to albumin ratios in hemodialysis patients
Abstract
Background: Zinc (Zn) deficiency is a common condition and could contribute to poor outcomes in hemodialysis patients. The aim of this study was to evaluate effects of Zn supplementation on serum copper (Cu) to Zn and CRP to albumin ratios in HD patients.
Methods: Seventy-seven HD patients were enrolled in a multicenter simple-blind randomized clinical trial. Only 37 HD patients completed the study; they were randomly divided into two groups and supplemented with zinc sulfate (n=17) or placebo (n=20) for two months. Serum Zn and Cu were measured by atomic absorption spectrophotometry. Serum albumin and hypersensitive-C-reactive protein were assessed by colorimetric and immunoturbidimetric method, respectively. Determinations were performed before and after the supplementation.
Results and conclusions: After two months of supplementation, serum Zn significantly increased and Cu to Zn ratio decreased in Zn supplemented group, but remained unchanged in placebo group. In parallel, serum albumin concentrations significantly increased and CRP to albumin ratio decreased in Zn supplemented group, only.Zn supplementation reduces Cu to Zn and CRP to albumin ratios in HD patients. These changes point towards an improvement in nutritional, oxidative and inflammatory statuses. The study findings suggest that correcting Zn deficiency reduce poor outcomes in HD patients.
References
2. Fung F, Sherrard DJ, Gillen DL, et al. Increased risk for cardiovascular mortality among malnourished end-stage renal disease patients. Am J Kidney Dis 2002;40:307-314.
3. Guo CH, Chen PC, Yeh MS, Hsiung DY, Wang CL. Cu/Zn ratios are associated with nutritional status, oxidative stress, inflammation, and immune abnormalities in patients on peritoneal dialysis. Clin Biochem 2011; 44:275-280.
4. Sun JY, Jing MY, Wang JF, et al. Effect of zinc on biochemical parameters and changes in related gene expression assessed by cDNA microarrays in pituitary of growing rats. Nutrition 2011;22:187-196.
5. Prasad AS. Clinical, Immunological, anti-inflammatory and antioxidant roles of zinc. Exp Gerontol 2008; 43:370-377.
6. Jern NA, VanBeber AD, Gorman MA, Weber CG, Liepa GU, Cochran CC. The effects of zinc supplementation on serum zinc concentration and protein catabolic rate in hemodialysis patients. J Ren Nutr 2000;10:148-153.
7. Ribeiro RC, Sales VS, Neves FAR, Draibe S, Brandao-Neto J. Effects of Zinc on Cell-Mediated Immunity in Chronic Hemodialysis Patients. Biol Trace Elem Res 2004;98:209-218.
8. Fellah H, Feki M, Soussi M, et al. Oxidative stress in end stage renal disease: evidence and association with cardiovascular events in Tunisian patients. Tunis Med 2006;84:724-729.
9. Guo CH, Wang CL. Effects of zinc supplementation on plasma copper/zinc ratios, oxidative stress, and immunological status in hemodialysis patients. Int J Med Sci 2013;10:79.
10. Miao X, Wang Y, Sun J, et al. Zinc protects against diabetes-induced pathogenic changes in the aorta: Roles of metallothionein and nuclear factor (erythroid-derived 2)-like 2. Cardiovasc Diabetol 2013;12:54.
11. Maggini S, Wintergerst ES, Beveridge S, Hornig DH. Selected vitamins and trace elements support immune function by strengthening epithelial barriers and cellular and humoral immune responses. Br J Nutr 2007; 98:29-35.
12. Sudha R, Ponsuganthi K, Jones R. Serum zinc and copper levels in maintenance haemodialysis patients and its relationship with depression and anxiety. Global Journal of Medicine and Public Health 2015;4.
13. Karahan SC, Deger O, Orem A, Ucar F, Erem C, Alver A. The effects of impaired trace element status on polymorphonuclear leukocyte activation in the development of vascular complications in type 2 diabetes mellitus. Clin Chem Lab Med 2001;39:109-115.
14. Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000;35:469-476.
15. Kawaguchi T, Tong L, Robinson BM, et al. C-reactive protein and mortality in hemodialysis patients: the dialysis outcomes and practice patterns study (DOPPS). Nephron Clin Pract 2011;117:167-178.
16. Poon PYK, Szeto CC, Kwan BCH, Chow KM, Li PKT. Relationship between CRP polymorphism and cardiovascular events in Chinese peritoneal dialysis. Clin J Am Soc Nephrol 2012;7:304-309.
17. Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS One 2015;10:e0132109.
18. Wu M, Guo J, Guo L, Zuo Q. The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer. Tumour Biol 2016;37:12525-12533.
19. Çağdaş M, Rencüzoğullari I, Karakoyun S. Assessment of relationship between C-reactive protein to albumin ratio and coronary artery disease severity in patients with acute coronary syndrome. Angiology 2017;70:361-368.
20. Jyh-Chang H, Ming-Yan J, Yi-Hua L, Charn-Ting W. Precedent fluctuation of serum hs-CRP to albumin ratios and mortality risk of clinically stable hemodialysis patients. PLoS One 2015;10:e0120266.
21. Rashidi AA, salehi M, Piroozmand A, Sagheb MM. Effects of zinc supplementation on serum zinc and C-Reactive Protein concentrations in hemodialysis patients. J Ren Nutr 2014;19:475-478.
22. Argani H, Mahdavi R, Ghorbani-haghjo A, Razzaghi E, Nikniaz L, Ghaemmaghami SJ. Effects of zinc supplementation on serum zinc and leptin levels, BMI, and body composition in hemodialysis patients. J Trace Elem Med Biol 2014;28:35-38.
23. Erten Y, Kayatas M, Sezer S, et al. Zinc deficiency: prevalence and causes in hemodialysis patients and effect on cellular immune response. Trans Proc 2010;30:850-852.
24. Dashti-Khavidaki S, Khalili H, Vahedi SM, Lessan-Pezeshki M. Serum zinc concentrations in patients on maintenance hemodialysis and its relationship with anemia, parathyroid hormone concentrations and pruritus severity. Saudi J Kidney Dis Transpl 2010;21:641-645
25. Shiota J, Tagawa H, Izumi N, Higashikawa S, Kasahara H. Effect of zinc supplementation on bone formation in hemodialysis patients with normal or low turnover bone. Ren Fail 2015;37:57-60.
26. Bozalioglu S, Ozkann Y, Turan M, Simsek B. Prevalence of zinc deficiency and immune response in short-term hemodialysis. Trace Elem Med Biol 2005;8:243-249.
27. Malavolta M, Giacconi R, Piacenza F, et al. Plasma copper/zinc ratio: an inflammatory/nutritional biomarker as predictor of all-cause mortality in elderly population. Biogerontology 2010;11:309-319.
28. De Martin R, Hoeth M, Hofer-Warbinek R, Schmid JA. The transcription factor NF-κB and the regulation of vascular cell function. Arterioscler Thromb Vasc Biol 2000;20:83-88.
29. Haase H, Rink L. The immune system and the impact of zinc during aging. Immun Ageing 2009;6:9.
30. Wintergerst ES, Maggini S, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab 2007;51:301-323.
31. Guo CH, Wang CL, Chen PC, Yang TC. Linkage of some trace elements, peripheral blood lymphocytes, inflammation, and oxidative stress in ESRD patients undergoing either hemodialysis or peritoneal dialysis. Periton Dialysis 2011;Int 31:583-59.
32. Ghaemmaghami J, Mahdavi R, Faramarzi E, Mohammadpour N, Argani H. Does zinc supplementation improve dietary intake, symptoms of eating problems, and serum zinc levels in hemodialysis patients? Dial Transplant 2010;39:530-533
Copyright (c) 2020 Marwa Hajji
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.