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Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study: A Prospective Cohort Study
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| Zeitschriftentitel: | Clinical Journal of the American Society of Nephrology |
|---|---|
| Personen und Körperschaften: | , , , , , , , , , , , |
| In: | Clinical Journal of the American Society of Nephrology, 13, 2018, 6, S. 907-915 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
Ovid Technologies (Wolters Kluwer Health)
|
| Schlagwörter: |
| author_facet |
Tonelli, Marcello Wiebe, Natasha Bello, Aminu Field, Catherine J. Gill, John S. Hemmelgarn, Brenda R. Holmes, Daniel T. Jindal, Kailash Klarenbach, Scott W. Manns, Braden J. Thadhani, Ravi Kinniburgh, David Tonelli, Marcello Wiebe, Natasha Bello, Aminu Field, Catherine J. Gill, John S. Hemmelgarn, Brenda R. Holmes, Daniel T. Jindal, Kailash Klarenbach, Scott W. Manns, Braden J. Thadhani, Ravi Kinniburgh, David |
|---|---|
| author |
Tonelli, Marcello Wiebe, Natasha Bello, Aminu Field, Catherine J. Gill, John S. Hemmelgarn, Brenda R. Holmes, Daniel T. Jindal, Kailash Klarenbach, Scott W. Manns, Braden J. Thadhani, Ravi Kinniburgh, David |
| spellingShingle |
Tonelli, Marcello Wiebe, Natasha Bello, Aminu Field, Catherine J. Gill, John S. Hemmelgarn, Brenda R. Holmes, Daniel T. Jindal, Kailash Klarenbach, Scott W. Manns, Braden J. Thadhani, Ravi Kinniburgh, David Clinical Journal of the American Society of Nephrology Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology |
| author_sort |
tonelli, marcello |
| spelling |
Tonelli, Marcello Wiebe, Natasha Bello, Aminu Field, Catherine J. Gill, John S. Hemmelgarn, Brenda R. Holmes, Daniel T. Jindal, Kailash Klarenbach, Scott W. Manns, Braden J. Thadhani, Ravi Kinniburgh, David 1555-9041 1555-905X Ovid Technologies (Wolters Kluwer Health) Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology http://dx.doi.org/10.2215/cjn.11451017 <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. We used adjusted logistic regression to evaluate the association between trace element status and four outcomes (death, cardiovascular events, systemic infection, and hospitalization). <jats:italic toggle="yes">A priori</jats:italic> hypotheses concerned (<jats:italic toggle="yes">1</jats:italic>) deficiency of zinc, selenium, and manganese and (<jats:italic toggle="yes">2</jats:italic>) excess of lead, arsenic, and mercury. Concentrations of the other 19 elements were tested in hypothesis-generating analyses.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Over 2 years of follow-up, 260 (20%) patients died, 285 (24%) experienced a cardiovascular event, 117 (10%) were hospitalized for systemic infection, and 928 (77%) were hospitalized for any cause. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not independently associated with higher risk of clinical outcomes. Lower concentrations of selenium were strongly and independently associated with death (odds ratio, 0.86 per decile; 99.2% confidence interval, 0.80 to 0.93) and all-cause hospitalization (odds ratio, 0.92 per decile; 99.2% confidence interval, 0.86 to 0.98). In exploratory analyses, higher copper concentrations were significantly associated with higher risk of death (odds ratio, 1.07 per decile; 99.2% confidence interval, 1.00 to 1.15), and cadmium levels in the highest decile were associated with higher risk of death (odds ratio, 1.89; 99.2% confidence interval, 1.06 to 3.38).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Lower levels of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with higher risk of clinical outcomes, but lower concentrations of selenium were strongly and independently associated with the risks of death and hospitalization.</jats:p> </jats:sec> A Prospective Cohort Study Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study Clinical Journal of the American Society of Nephrology |
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10.2215/cjn.11451017 |
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Ovid Technologies (Wolters Kluwer Health), 2018 |
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Ovid Technologies (Wolters Kluwer Health), 2018 |
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Ovid Technologies (Wolters Kluwer Health) |
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Clinical Journal of the American Society of Nephrology |
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49 |
| title_sub |
A Prospective Cohort Study |
| title |
Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_unstemmed |
Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_full |
Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_fullStr |
Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_full_unstemmed |
Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_short |
Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_sort |
concentrations of trace elements and clinical outcomes in hemodialysis patients : a prospective cohort study |
| topic |
Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology |
| url |
http://dx.doi.org/10.2215/cjn.11451017 |
| publishDate |
2018 |
| physical |
907-915 |
| description |
<jats:sec>
<jats:title>Background and objectives</jats:title>
<jats:p>Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Design, setting, participants, & measurements</jats:title>
<jats:p>We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. We used adjusted logistic regression to evaluate the association between trace element status and four outcomes (death, cardiovascular events, systemic infection, and hospitalization). <jats:italic toggle="yes">A priori</jats:italic> hypotheses concerned (<jats:italic toggle="yes">1</jats:italic>) deficiency of zinc, selenium, and manganese and (<jats:italic toggle="yes">2</jats:italic>) excess of lead, arsenic, and mercury. Concentrations of the other 19 elements were tested in hypothesis-generating analyses.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>Over 2 years of follow-up, 260 (20%) patients died, 285 (24%) experienced a cardiovascular event, 117 (10%) were hospitalized for systemic infection, and 928 (77%) were hospitalized for any cause. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not independently associated with higher risk of clinical outcomes. Lower concentrations of selenium were strongly and independently associated with death (odds ratio, 0.86 per decile; 99.2% confidence interval, 0.80 to 0.93) and all-cause hospitalization (odds ratio, 0.92 per decile; 99.2% confidence interval, 0.86 to 0.98). In exploratory analyses, higher copper concentrations were significantly associated with higher risk of death (odds ratio, 1.07 per decile; 99.2% confidence interval, 1.00 to 1.15), and cadmium levels in the highest decile were associated with higher risk of death (odds ratio, 1.89; 99.2% confidence interval, 1.06 to 3.38).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Lower levels of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with higher risk of clinical outcomes, but lower concentrations of selenium were strongly and independently associated with the risks of death and hospitalization.</jats:p>
</jats:sec> |
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| author | Tonelli, Marcello, Wiebe, Natasha, Bello, Aminu, Field, Catherine J., Gill, John S., Hemmelgarn, Brenda R., Holmes, Daniel T., Jindal, Kailash, Klarenbach, Scott W., Manns, Braden J., Thadhani, Ravi, Kinniburgh, David |
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| description | <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. We used adjusted logistic regression to evaluate the association between trace element status and four outcomes (death, cardiovascular events, systemic infection, and hospitalization). <jats:italic toggle="yes">A priori</jats:italic> hypotheses concerned (<jats:italic toggle="yes">1</jats:italic>) deficiency of zinc, selenium, and manganese and (<jats:italic toggle="yes">2</jats:italic>) excess of lead, arsenic, and mercury. Concentrations of the other 19 elements were tested in hypothesis-generating analyses.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Over 2 years of follow-up, 260 (20%) patients died, 285 (24%) experienced a cardiovascular event, 117 (10%) were hospitalized for systemic infection, and 928 (77%) were hospitalized for any cause. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not independently associated with higher risk of clinical outcomes. Lower concentrations of selenium were strongly and independently associated with death (odds ratio, 0.86 per decile; 99.2% confidence interval, 0.80 to 0.93) and all-cause hospitalization (odds ratio, 0.92 per decile; 99.2% confidence interval, 0.86 to 0.98). In exploratory analyses, higher copper concentrations were significantly associated with higher risk of death (odds ratio, 1.07 per decile; 99.2% confidence interval, 1.00 to 1.15), and cadmium levels in the highest decile were associated with higher risk of death (odds ratio, 1.89; 99.2% confidence interval, 1.06 to 3.38).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Lower levels of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with higher risk of clinical outcomes, but lower concentrations of selenium were strongly and independently associated with the risks of death and hospitalization.</jats:p> </jats:sec> |
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| spelling | Tonelli, Marcello Wiebe, Natasha Bello, Aminu Field, Catherine J. Gill, John S. Hemmelgarn, Brenda R. Holmes, Daniel T. Jindal, Kailash Klarenbach, Scott W. Manns, Braden J. Thadhani, Ravi Kinniburgh, David 1555-9041 1555-905X Ovid Technologies (Wolters Kluwer Health) Transplantation Nephrology Critical Care and Intensive Care Medicine Epidemiology http://dx.doi.org/10.2215/cjn.11451017 <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. We used adjusted logistic regression to evaluate the association between trace element status and four outcomes (death, cardiovascular events, systemic infection, and hospitalization). <jats:italic toggle="yes">A priori</jats:italic> hypotheses concerned (<jats:italic toggle="yes">1</jats:italic>) deficiency of zinc, selenium, and manganese and (<jats:italic toggle="yes">2</jats:italic>) excess of lead, arsenic, and mercury. Concentrations of the other 19 elements were tested in hypothesis-generating analyses.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Over 2 years of follow-up, 260 (20%) patients died, 285 (24%) experienced a cardiovascular event, 117 (10%) were hospitalized for systemic infection, and 928 (77%) were hospitalized for any cause. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not independently associated with higher risk of clinical outcomes. Lower concentrations of selenium were strongly and independently associated with death (odds ratio, 0.86 per decile; 99.2% confidence interval, 0.80 to 0.93) and all-cause hospitalization (odds ratio, 0.92 per decile; 99.2% confidence interval, 0.86 to 0.98). In exploratory analyses, higher copper concentrations were significantly associated with higher risk of death (odds ratio, 1.07 per decile; 99.2% confidence interval, 1.00 to 1.15), and cadmium levels in the highest decile were associated with higher risk of death (odds ratio, 1.89; 99.2% confidence interval, 1.06 to 3.38).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Lower levels of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with higher risk of clinical outcomes, but lower concentrations of selenium were strongly and independently associated with the risks of death and hospitalization.</jats:p> </jats:sec> A Prospective Cohort Study Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study Clinical Journal of the American Society of Nephrology |
| spellingShingle | Tonelli, Marcello, Wiebe, Natasha, Bello, Aminu, Field, Catherine J., Gill, John S., Hemmelgarn, Brenda R., Holmes, Daniel T., Jindal, Kailash, Klarenbach, Scott W., Manns, Braden J., Thadhani, Ravi, Kinniburgh, David, Clinical Journal of the American Society of Nephrology, Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study, Transplantation, Nephrology, Critical Care and Intensive Care Medicine, Epidemiology |
| title | Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_full | Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_fullStr | Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_full_unstemmed | Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_short | Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| title_sort | concentrations of trace elements and clinical outcomes in hemodialysis patients : a prospective cohort study |
| title_sub | A Prospective Cohort Study |
| title_unstemmed | Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients : A Prospective Cohort Study |
| topic | Transplantation, Nephrology, Critical Care and Intensive Care Medicine, Epidemiology |
| url | http://dx.doi.org/10.2215/cjn.11451017 |