Trace element imbalances in patients undergoing chronic hemodialysis therapy - Report of an observational study in a cohort of Portuguese patients

Introduction: Patients with end-stage renal disease undergoing hemodialysis therapy are at risk of developing deficiencies of essential trace elements and/or overload of toxic trace elements, both of which may significantly affect their clinical status of. Those imbalances may result from the disease itself but also from the quality of the therapeutic process, namely the hemodialysis process, which has greatly evolved in the last decades. Thus, old observations that have been assumed as very well-proven have been recently questioned. In this case-control study we evaluate the current trace elements status in a group of Portuguese patients under hemodialysis therapy. Material and methods: Serum samples from patients (n = 93), collected for the routine periodic control of Al levels, were analyzed for a wide panel of trace elements (Li, Al, Mn, Co, Ni, Cu, Zn, Se, Rb, Sr, Mo, Cd, Ba, Pb) using inductively coupled plasma mass spectrometry technique (hemodialysis patients' group). For comparison purposes, samples of individuals with no evidence of renal disease according to standard laboratory analytical criteria (n = 50) were also analyzed (control group). Results: The results showed significant differences between the two groups, with higher values in hemodialysis patients group for Al (14.6 vs. 9.5 mu g/L), Co, Ni, Sr, Mo (4.5 vs. 1.4 mu g/L), Cd (0.058 vs. 0.025 mu g/L) and Pb (0.55 vs. 0.30 mu g/L); and lower values in hemodialysis patients group for Li (4.0 vs. 75.8 Mn, Cu (943.5 vs. 1038.5 Zn (943.5 vs. 1038.5 mu g/L), Se (71.5 vs. 103.8 mu g/L), Rb (202.4 vs. 300.3 mu g/L) and Ba (0.65 vs. 8.7 mu g/L. Conclusion: This study confirms that hemodialysis patients tend to present significant trace elements imbalances, which may be related to the higher morbidity and mortality observed in this specific patients' group.