Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 105-8471, Japan.
Clin Exp Nephrol. 2021 Jul;25(7):771-778. doi: 10.1007/s10157-021-02046-3. Epub 2021 Mar 17.
Although zinc deficiency is common among dialyzed patients, its prevalence among non-dialyzed subjects and its relationship to renal function remain unclear.
We selected 816 non-dialyzed subjects (495 males; mean age, 56 ± 18 years) who underwent measurement of serum zinc at Jikei University Hospital between April 2018 and March 2019 using the Standardized Structured Medical Information eXchange2 (SS-MIX2) system, a global standard in Japan that enables collection of structured medical records with automatic data transfer to a registry database system. A serum zinc level of 60-80 μg/dL was defined as marginal zinc deficiency and a level of < 60 μg/dL as absolute zinc deficiency. We investigated factors associated with serum zinc using multiple regression analysis.
Marginal and absolute zinc deficiency were present in 52.3% and 30.6% of subjects, respectively. Serum zinc levels tended to decrease with increasing stage of chronic kidney disease (CKD) (P = 0.051). Estimated glomerular filtration rate (eGFR) was not independently associated with serum zinc levels. Instead, serum albumin (t = 4.69, P < 0.01), hemoglobin (t = 2.54, P = 0.01) and mean corpuscular volume (MCV) (t = - 2.20, P = 0.03) were independently associated with serum zinc. In sensitivity analyses, serum zinc was not associated with either serum copper- or iron-related parameters.
This large-scale study clarified the prevalence of zinc deficiency among non-dialyzed Japanese subjects. In addition, eGFR was not independently associated with serum zinc, probably due to confounding factors, such as nutritional status and degree of anemia. Further investigations are needed to clarify the epidemiology of zinc deficiency and its associations with CKD.
尽管锌缺乏在透析患者中很常见，但在非透析患者中的患病率及其与肾功能的关系尚不清楚。
我们选择了 816 名非透析患者（495 名男性；平均年龄 56±18 岁），他们于 2018 年 4 月至 2019 年 3 月在日本顺天堂大学医院使用标准化结构化医疗信息交换 2 系统（SS-MIX2）测量血清锌水平，该系统是日本的全球标准，可用于收集结构化病历并自动将数据传输到注册数据库系统。血清锌水平为 60-80μg/dL 定义为边缘锌缺乏， < 60μg/dL 定义为绝对锌缺乏。我们使用多元回归分析调查了与血清锌相关的因素。
分别有 52.3%和 30.6%的患者存在边缘和绝对锌缺乏。血清锌水平随慢性肾脏病（CKD）分期的增加而降低（P = 0.051）。估算肾小球滤过率（eGFR）与血清锌水平无独立相关性。相反，血清白蛋白（t = 4.69，P < 0.01）、血红蛋白（t = 2.54，P = 0.01）和平均红细胞体积（MCV）（t = -2.20，P = 0.03）与血清锌独立相关。在敏感性分析中，血清锌与血清铜或铁相关参数均无相关性。
这项大规模研究阐明了非透析日本患者中锌缺乏的流行情况。此外，eGFR 与血清锌无独立相关性，这可能是由于营养状况和贫血程度等混杂因素所致。需要进一步研究来阐明锌缺乏症的流行病学及其与 CKD 的关系。
