Abstract
BackgroundChromium is an essential trace metal that reduces oxidative stress and inflammation. In patients undergoing maintenance hemodialysis (MHD), a correlation among chromium exposure, inflammation, and malnutrition remains unclear. This study examined the possible effects of serum chromium levels (SCLs) in MHD patients.MethodsInitially, 732 MHD patients in dialysis centers were recruited. A total of 647 patients met the inclusion criteria and were stratified by SCL into four equal-sized groups: first quartile (< 0.29 μg/L), second quartile (0.29–0.56 μg/L), third quartile (0.57–1.06 μg/L), and fourth quartile (> 1.06 μg/L). Demographic, biochemical, and dialysis-related data were obtained for analyses. The analysis included nutritional and inflammatory markers.ResultsAs compared with the highest quartile group, more subjects in the lowest quartile group were of an older age; had lower hemoglobin and creatinine levels; had a higher prevalence of DM and malnutrition (serum albumin level < 3.6 g/dL); and higher serum transferrin saturation and ferritin levels. A stepwise multiple linear regression analysis revealed a significant negative correlation between malnutrition and SCL (β coefficient = − 0.129, p = 0.012) and negative associations among body mass index (β coefficient = − 0.010, p = 0.041), ferritin (β coefficient = − 0.107, p = 0.001) and SCL. A multivariate logistic regression analysis also demonstrated a negative correlation between malnutrition and SCL. With a 10-fold increase in SCL, the risk ratio of malnutrition was 0.49 (95% confidence interval: 0.25–0.96; p = 0.039).ConclusionsSCL is significantly associated with malnutrition in MHD patients. Further evaluation of the relationship between clinical outcomes (morbidity/mortality) and SCL is necessitated.
Highlights
Chromium is an essential trace metal that reduces oxidative stress and inflammation
The groups did not differ in terms of serum albumin; cholesterol; triglyceride; corrected calcium and phosphate levels; intact parathyroid hormone (iPTH); high-sensitivity C-reactive protein (hsCRP), the presence of viral hepatitis B antigen and viral hepatitis C antibody
After adjusting for potential variables, we revealed that age of > 65 years (OR = 1.80; 95% confidence interval (CI): 1.02–3.19; p = 0.043) and hsCRP of > 3.0 mg/L (OR = 2.15; 95% CI: 1.22–3.82; p = 0.009) were independent and positive predictors of malnutrition, but cholesterol (OR = 0.99; 95% CI: 0.98–1.00; p = 0.005), creatinine (OR = 0.73; 95% CI: 0.64–0.84; p < 0.001) and log Serum chromium level (SCL) (OR = 0.49; 95% CI: 0.25–0.96; p = 0.039) were independent and negative predictors of malnutrition in forward stepwise multivariate logistic regression analysis (Table 3)
Summary
In patients undergoing maintenance hemodialysis (MHD), a correlation among chromium exposure, inflammation, and malnutrition remains unclear. This study examined the possible effects of serum chromium levels (SCLs) in MHD patients. Studies have suggested that trivalent chromium is an essential nutrient; potentiates insulin action in peripheral tissue; and is essential for lipid, protein, and fat metabolism in animals and humans [1, 2]. The lower plasma chromium level is associated with hyperglycemia, insulin resistance, high inflammatory status and increased cardiovascular risk in humans [2]. Chromium has been shown to accumulate in the bones of patients with end-stage renal disease (ESRD), and increased serum chromium levels (SCLs) have been found in patients undergoing maintenance hemodialysis (MHD) [7]. No study mentioned the clinical advantages or disadvantages of an elevated SCL in patients undergoing MHD until now
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