IJCRR - Vol 08 Issue 10, May
Date of Publication: 22-May-2016
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INFLUENCE OF END STAGE RENAL DISEASE IN ALTERATION OF SOME TRACE ELEMENTS IN SUDANESE PATIENTS
Author: Kamal Eldin Ahmed Abdelsalam, Eshteag Mohammed Musllem
Abstract:Background: The role of trace elements in hemodialysis (HD) patients has not yet been clearly recognized. To minimize the health consequences of persistent HD, the levels of trace elements should be seriously adjusted.
Methods: The study was across-sectional conducted in Khartoum state ofSudan between August 2013 and April 2015 included 150patients with end stage renal disease treated with hemodialysis and 75 healthy volunteers as control group. Informed consent was assigned by each participant before taking the blood sample. All samples were analyzed for magnesium, zinc and copper. Results: Compared with healthy controls, in hemodialysis patients average serum levels of zinc (Zn) (663 \?g/L) and copper (Cu) (797\?g/L) were insignificantly different; however, magnesium (Mg) levels (38.61 mg/L) were significantly increased. According to sex of ESRD patients, serum Mg level was increased significantly in females, while insignificant changes were observed in Culevel. This study stated that Zn, Cu and Mg levels were significantly increased in elder patients more than younger ones. Zn, Cu and Mg were increased as increasing duration of dialysis, changing significantly in serum Zn and Cu. Conclusions: Our results concluded that in hemodialysis, aging, and sex have significant effects on Zn, Cu and Mg.
Keywords: Copper, ESRD, Hemodialysis, Magnesium, Zinc
End-stage renal disease (ESRD) has a high prevalence and progression throughout the world and it is a common co-morbidity disease. Many people around the world suffer from ESRD and require long-term dialysis. Despite dialysis treatment, ESRD patients still have high morbidity and mortality rates. Recent studies have suggested that the dialysis treatment is associated with some complications and incon Svenient events .Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are more common in certain patient populations, including the elderly, those with youth-onset diabetes mellitus, obese persons, some ethnic groups, and disadvantaged population . Patients from low and middle income countries are often the least able to deal with the burden of ESRD and the health-care facilities of these countries least able to provide the demand for convinced access to renal replacement therapies . ESRD patients are commonly suffered of malnutrition and/or infl ammation . The accurate assessment of nutritional status and body composition is of highly importance in providing nutritional care to patients with CKD and ESRD, as malnutrition and the trace elements wasting syndrome are among the strongest risk factors for morbidity and mortality . Study of Guo et al. mentions that long-term dialysis leads to signifi cant changes in the concentrations of some trace elements. The human body needs a number of minerals in trace quantities. These include iron, copper, magnesium and zinc. Usually mineral defi ciency binds more than one, and these collective defi ciencies have cumulative effect on health. Trace elements play important roles in human body because they serve a variety of functions. Some serve multiple functions ranging from representing as cofactors in enzyme reactions to organizing and contributing to the hardness of bone. Metal ions are always joined to particular proteins where they often play a crucial part in maintaining the protein’s three dimensional structure . Zinc is a cofactor in more than 100 enzymatic reactions, essential component of nuclear DNA binding proteins and serves in genes’ codes for metallothioneins. Copper also is essential cofactor in several reactions concerning iron use, collagen synthesis, suppression of free radicals and serves in the expression of genes for several enzymes. While, magnesium in human body is needed for more than 300 biochemical reactions. It supports and helps to maintain normal functions of nerve, muscle, and healthy immune system, keeps the heart beat steady, and helps bones remain strong . Many of the functions described above are vital metabolic functions. Defi ciency of any of those trace minerals can produce a variety of diseases . The aim of this study was to assess the levels of serum zinc, copper and magnesium among ESRD Sudanese patients before dialysis as affected by gender, age and duration.
MATERIALS AND METHODS
Study area: The study was conducted in Sudan, Khartoum state, in Omdurman Teaching Hospital and Khartoum North Center for dialysis. Study design: This was across-sectional study. Study period: The study was carried out between August 2013 and April 2015. Sample size and study population: the study included 150 (75 males, 75 females) ESRD patients(already diagnosed patients with end stage renal failure under dialysis). Mean age of patients was 33.14±4.58 years. Control group was consisted of 75 healthy volunteers whose mean age was matched (35.6±5.64). Any patient with disease can affect the results was excluded as well as the patients refused to participate in the study. Ethical clearance: The ethical committee of Omdurman Islamic University approved the ethical clearance of the present study. Informed consent was obtained from each participant before taking the samples. Data collection: data was collected using pre-prepared questionnaire which include age, sex, duration of renal failure, duration of dialysis, and patients health condition. Sampling: 5 mL venous blood was obtained from antecubital vein by standard venipuncture technique without venous stasis, in serum separator tube. Serum was separated after 20 minutes and stored in -20o C till time of analysis. Methods of estimation: All samples were analyzed after warming to room temperature.Analysis of zinc and copper is carried in the center of researches, Information Technology College using Atomic absorption spectrometer (Thermo Scientifi c™ iCE™ 3300 AAS, USA) following the manufacturer procedure. Serum magnesium was measured using mass spectrometry (ICP-MS, Agilent 7700x, Agilent Technologies, Tokyo, Japan) as described by Harari et al . Statistical analyses: The data obtained were expressed as mean values ± SD. Statistical analyses were performed using SPSS (Statistical Package for Social Sciences) version 19.00 (SPSS, Inc., Chicago, IL). Differences in mean values between groups were evaluated by a Student’s t-test. P-value was statistically signifi cant at P<0.05.
The results of the present study indicated that there is insignifi cant differences in zinc (Zn), and copper (Cu) between patients and controls with p-values of more than 0.05% for all results. While, magnesium (Mg) levels were signifi cantly increased in ESRD patients
ESRD patients were classifi ed according to age into two groups; one group included patients of less than 18 years and the other group included the patients of 18 to 40 years old. The results showed signifi cant changes in all tested parameters (Zn, Cu & Mg) (Table 3).
Traceelements in human plasma are essential nutrients with many functions. Abnormalities of trace elements are primarily the result of CRF, and they may be sometimes greatly turned by the dialysis . In the present study, magnesium levels in ESRD patients were increased signifi cantly (p = 0.000) comparing to healthy control volunteers. This result was in contrast to Ortega et al. who reported that in CKD magnesium levels show insignificant changes in patients comparing to controls. While the levels of copper and zinc showed insignifi cant variations between patients and control. These results were in agreement with Bhogade et al. who reported that there is a signifi cant decrease in CRF patients comparing to healthy control persons. In this study, ESRD patients were classifi ed into males and females. Accordingly, there was signifi cant reduction of serum zinc levels in females when compared to males (p< 0.05). Furthermore, serum copper were insignifi cantly decreased in females (p> 0.05), but serum magnesium level were signifi cantly increased in males more than females (p< 0.001). However, EL-Habibi et al.  showed that Cu and Zn are reduced insignifi cantly in ESRD females comparing to ESRD males; On the other hand, João et al.  showed no changes in serum magnesium levels (p> 0.05) between ESRD males and females patient. The study revealed that serum levels of Zn, Cu and Mg in ESRD patients of less than 18 years old were signifi cantly decreased when compared to ESRD patients of more than 18 years old (p < 0.05). The results of Kiziltas et al.  and Cunningham et al.  were in line with our results but with few differences in restriction and limitation of age groups. Moreover, ESRD patients were classifi ed according to duration of hemodialysis into two groups, patients who treated with hemodialysis for less than one year and more than one year.Comparing to patients who treated with hemodialysis for less than one year, Cu and Zn levels in serum of patients who treated for more than one year showed signifi cant increase (p < 0.05) while serum Mg level showed insignifi - cant increase (p > 0.05). Mastrangelo et al.  revealed that Mg, Cu and Zn concentrations in the blood increased with increasing the treatment time of dialysis. In contrast, Cunningham et al.  and Koca et al.  reported that CRF patients for more than fi ve years experienced low results in Cu and Zn much less than patients who have started the dialysis treatment more recently.
Compared with healthy controls, in hemodialysis patients’ average serum Zn and Cu were insignifi cantly different; however, Mg levels were signifi cantly increased. According to sex, the results of ESRD patients showed signifi cant increase in male patients, serum Mg level was increased signifi cantly in females, while insignifi cant changes were observed in Cu level. This study stated that Zn, Cu and Mg levels were signifi cantly increased in elder patients more than younger ones. Zn, Cu and Mg were increased as increasing duration of dialysis changing signifi cantly in serum Zn and Cu.
Authors are grateful to Center of Researches, Information Technology College and V C R Center for providing machines and reagents of this study. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Conflict of Interests The authors declare that they have no confl ict of interests. Source of funding This study was carried out by self-fi nancing.
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