Department of Internal Medicine, Division of Nephrology, Mackay Memorial Hospital, Taipei, Taiwan.
Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
J Investig Med. 2019 Aug;67(6):995-1001. doi: 10.1136/jim-2018-000833. Epub 2019 Feb 4.
Anemia is common in chronic kidney disease (CKD) and may be affected by trace element concentrations. While the concentrations of trace elements are known to be altered in CKD, the relationship between trace element and hemoglobin concentrations has not been systematically investigated in a large cohort. This study aims to examine associations between trace element concentrations and anemia in patients with CKD. Data from the National Health and Nutrition Examination Survey collected from 2011 to 2014 were used for this analysis. The participants who were more than 20 years old were included. A total of 3057 participants were included; the final cohort was divided into two groups based on CKD status. The concentrations of hemoglobin, iron, zinc, and manganese were significantly lower in participants with than without CKD (all p<0.05). Multivariate analyses showed that in patients without CKD, hemoglobin concentrations correlated positively with iron, zinc, and cadmium (β=0.005, 0.009, and 0.33, respectively), but correlated negatively with copper levels (β=-0.002). In patients with CKD, hemoglobin concentrations correlated positively with cadmium and selenium, but negatively with copper levels (β=0.57, 0.007, and -0.008, respectively). The serum iron concentration was found to correlate positively with zinc, cadmium, and selenium, but negatively with copper and manganese concentrations in the total study population (all p<0.05). The associations between serum concentrations of trace elements and hemoglobin differ between patients with and without CKD. Further investigations are warranted to determine whether patients with CKD have distinct trace element requirements.
贫血在慢性肾脏病（CKD）中很常见，可能受微量元素浓度的影响。虽然已知 CKD 患者的微量元素浓度会发生改变，但在大型队列中尚未系统研究微量元素与血红蛋白浓度之间的关系。本研究旨在检查 CKD 患者的微量元素浓度与贫血之间的关联。本分析使用了 2011 年至 2014 年国家健康和营养调查收集的数据。纳入年龄超过 20 岁的参与者。共纳入 3057 名参与者；最终队列根据 CKD 状态分为两组。与无 CKD 的参与者相比，有 CKD 的参与者的血红蛋白、铁、锌和锰浓度明显更低（均 P<0.05）。多变量分析显示，在无 CKD 的患者中，血红蛋白浓度与铁、锌和镉呈正相关（β=0.005、0.009 和 0.33），但与铜水平呈负相关（β=-0.002）。在 CKD 患者中，血红蛋白浓度与镉和硒呈正相关，但与铜水平呈负相关（β=0.57、0.007 和-0.008）。全人群的血清铁浓度与锌、镉和硒呈正相关，与铜和锰浓度呈负相关（均 P<0.05）。血清微量元素浓度与血红蛋白之间的关联在有无 CKD 的患者之间存在差异。需要进一步的研究来确定 CKD 患者是否具有不同的微量元素需求。
