Serum trace metal association with response to erythropoiesis stimulating agents in incident and prevalent hemodialysis patients

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作者
Michael E. Brier
Jessica R. Gooding
James M. Harrington
Jason P. Burgess
Susan L. McRitchie
Xiaolan Zhang
Brad H. Rovin
Jon B. Klein
Jonathan Himmelfarb
Susan J. Sumner
Michael L. Merchant
机构
[1] University of Louisville,Kidney Disease Program, Department of Medicine
[2] The Robley Rex Veterans Affairs Medical Center,NIH Common Fund Eastern Regional Comprehensive Metabolomics Resource Core (ERCMRC) and Nutrition Research Institute
[3] NIH Eastern Regional Comprehensive Metabolomics Resource Core,Analytical Sciences Department
[4] RTI International,Department of Internal Medicine
[5] University of North Carolina,Department of Medicine, Kidney Research Institute
[6] RTI International,Center for Integrated Environmental Health Sciences
[7] Ohio State University,undefined
[8] University of Washington,undefined
[9] University of Louisville,undefined
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Scientific Reports | / 10卷
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摘要
Alterations in hemodialysis patients’ serum trace metals have been documented. Early studies addressing associations levels of serum trace metals with erythropoietic responses and/or hematocrit generated mixed results. These studies were conducted prior to current approaches for erythropoiesis stimulating agent (ESA) drug dosing guidelines or without consideration of inflammation markers (e.g. hepcidin) important for regulation of iron availability. This study sought to determine if the serum trace metal concentrations of incident or chronic hemodialysis patients associated with the observed ESA response variability and with consideration to ESA dose response, hepcidin, and high sensitivity C-reactive protein levels. Inductively-coupled plasma-mass spectrometry was used to measure 14 serum trace metals in 29 incident and 79 prevalent dialysis patients recruited prospectively. We compared these data to three measures of ESA dose response, sex, and dialysis incidence versus dialysis prevalence. Hemoglobin was negatively associated with ESA dose and cadmium while positively associated with antimony, arsenic and lead. ESA dose was negatively associated with achieved hemoglobin and vanadium while positively associated with arsenic. ESA response was positively associated with arsenic. Vanadium, nickel, cadmium, and tin were increased in prevalent patients. Manganese was increased in incident patients. Vanadium, nickel, and arsenic increased with time on dialysis while manganese decreased. Changes in vanadium and manganese were largest and appeared to have some effect on anemia. Incident and prevalent patients’ chromium and antimony levels exceeded established accepted upper limits of normal.
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