Associations Between Blood Trace Element Levels and Nutritional Status in Maintenance Hemodialysis

Abstract

We aimed to investigate the associations between blood trace element levels and nutritional status in patients undergoing maintenance hemodialysis (MHD). This cross-sectional study included patients undergoing MHD who were treated at our center in September 2019. Clinical and demographic data and blood samples were collected before hemodialysis sessions, and the levels of manganese, lead, selenium, zinc, and copper were measured by inductively coupled plasma mass spectrometry. The Simplified Nutritional Appetite Questionnaire scale was used to assess patient appetite. Skinfold thickness, bicep circumference, upper arm muscle circumference, 7-point Subjective Global Assessment, Nutritional Risk Screening 2002 (NRS 2002), and Geriatric Nutritional Risk Index (GNRI) were used to assess patient nutritional status. Univariate and multivariate logistic regression analyses were performed to study the relationship between trace elements and nutritional indicators. In total, 118 patients (64 males and 54 females) were included, with a median dialysis vintage of 34.0months (16.0-54.5months) and an average age of 63.20±14.26years. Malnourished patients, as defined by the GNRI, Subjective Global Assessment, and NRS 2002, accounted for 28.0%, 49.2%, and 26.3% of enrolled patients, respectively. The multivariate binary logistic regression showed that higher blood copper levels were independently associated with nutritional risk defined as GNRI ≤91.2 (odds ratio [OR]=1.003, 95% confidence interval [CI] = 1.000-1.006; P=.020), whereas lower blood zinc levels (OR=0.634, 95% CI = 0.439-0.916; P=.015), blood zinc<4.220mg/L (OR=3.723, 95% CI = 1.274-10.879; P=.016), lower blood selenium levels (OR=0.959, 95% CI = 0.929-0.990; P=.010), and blood selenium<85μg/L (OR=5.568, 95% CI = 1.039-29.840; P=.045) were independently associated with a nutritional risk defined as NRS 2002≥3. Higher levels of blood copper and lower levels of blood zinc and selenium were independently associated with higher nutritional risk in MHD patients.