Marcello Tonelli1, Natasha Wiebe2, Aminu Bello2, Catherine J Field3, John S Gill4, Brenda R Hemmelgarn5, Daniel T Holmes6, Kailash Jindal2, Scott W Klarenbach2, Braden J Manns5, Ravi Thadhani7, David Kinniburgh8. 1. Department of Medicine, University of Calgary, Calgary, Canada. Electronic address: tonelli.admin@ucalgary.ca. 2. Department of Medicine, University of Alberta, Edmonton, Canada. 3. Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada. 4. Department of Medicine, University of British Columbia, Vancouver, Canada. 5. Department of Medicine, University of Calgary, Calgary, Canada. 6. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada. 7. Department of Medicine, Harvard University, Boston, MA. 8. Department of Physiology & Pharmacology, University of Calgary, Calgary, Canada.
Abstract
BACKGROUND: Low concentrations and excessive concentrations of trace elements have been commonly reported in hemodialysis patients, but available studies have several important limitations. STUDY DESIGN: Random sample of patients drawn from a prospective cohort. SETTING & PARTICIPANTS: 198 incident hemodialysis patients treated in 3 Canadian centers. MEASUREMENTS: We used mass spectrometry to measure plasma concentrations of the 25 elements at baseline, 6 months, 1 year, and 2 years following enrollment in the cohort. We focused on low concentrations of zinc, selenium, and manganese and excessive concentrations of lead, arsenic, and mercury; low and excessive concentrations of the other 19 trace elements were treated as exploratory analyses. Low and excessive concentrations were based on the 5th and 95th percentile plasma concentrations from healthy reference populations. RESULTS: At all 4 occasions, low zinc, selenium, and manganese concentrations were uncommon in study participants (≤5.1%, ≤1.8%, and ≤0.9% for zinc, selenium, and manganese, respectively) and a substantial proportion of participants had concentrations that exceeded the 95th percentile (≥65.2%, ≥74.2%, and ≥19.7%, respectively). Almost all participants had plasma lead concentrations above the 95th percentile at all time points. The proportion of participants with plasma arsenic concentrations exceeding the 95th percentile was relatively constant over time (9.1%-9.8%); the proportion with plasma mercury concentrations that exceeded the 95th percentile varied between 15.2% and 29.3%. Low arsenic, platinum, tungsten, and beryllium concentrations were common (>50%), as were excessive cobalt, manganese, zinc, vanadium, cadmium, selenium, barium, antimony, nickel, molybdenum, lead, and chromium concentrations. CONCLUSIONS: There was no evidence that low zinc, selenium, or manganese concentrations exist in most contemporary Canadian hemodialysis patients. Some patients have excessive plasma arsenic and mercury concentrations, and excessive lead concentrations were common. These findings require further investigation.
BACKGROUND: Low concentrations and excessive concentrations of trace elements have been commonly reported in hemodialysis patients, but available studies have several important limitations. STUDY DESIGN: Random sample of patients drawn from a prospective cohort. SETTING & PARTICIPANTS: 198 incident hemodialysis patients treated in 3 Canadian centers. MEASUREMENTS: We used mass spectrometry to measure plasma concentrations of the 25 elements at baseline, 6 months, 1 year, and 2 years following enrollment in the cohort. We focused on low concentrations of zinc, selenium, and manganese and excessive concentrations of lead, arsenic, and mercury; low and excessive concentrations of the other 19 trace elements were treated as exploratory analyses. Low and excessive concentrations were based on the 5th and 95th percentile plasma concentrations from healthy reference populations. RESULTS: At all 4 occasions, low zinc, selenium, and manganese concentrations were uncommon in study participants (≤5.1%, ≤1.8%, and ≤0.9% for zinc, selenium, and manganese, respectively) and a substantial proportion of participants had concentrations that exceeded the 95th percentile (≥65.2%, ≥74.2%, and ≥19.7%, respectively). Almost all participants had plasma lead concentrations above the 95th percentile at all time points. The proportion of participants with plasma arsenic concentrations exceeding the 95th percentile was relatively constant over time (9.1%-9.8%); the proportion with plasma mercury concentrations that exceeded the 95th percentile varied between 15.2% and 29.3%. Low arsenic, platinum, tungsten, and beryllium concentrations were common (>50%), as were excessive cobalt, manganese, zinc, vanadium, cadmium, selenium, barium, antimony, nickel, molybdenum, lead, and chromium concentrations. CONCLUSIONS: There was no evidence that low zinc, selenium, or manganese concentrations exist in most contemporary Canadian hemodialysis patients. Some patients have excessive plasma arsenic and mercury concentrations, and excessive lead concentrations were common. These findings require further investigation.
Authors: Marcello Tonelli; Natasha Wiebe; Aminu Bello; Catherine J Field; John S Gill; Brenda R Hemmelgarn; Daniel T Holmes; Kailash Jindal; Scott W Klarenbach; Braden J Manns; Ravi Thadhani; David Kinniburgh Journal: Clin J Am Soc Nephrol Date: 2018-03-29 Impact factor: 8.237
Authors: James M Harrington; Laura G Haines; Amal S Essader; Chamindu Liyanapatirana; Eric A Poitras; Frank X Weber; Keith E Levine; Reshan A Fernando; Veronica G Robinson; Suramya Waidyanatha Journal: Anal Lett Date: 2021-03-01 Impact factor: 2.329