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Association Between the Blood Copper-Zinc (Cu/Zn) Ratio and Anemia in Patients Undergoing Maintenance Hemodialysis

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Abstract

Copper (Cu) and zinc (Zn) imbalances are common in dialysis patients. This study aimed to investigate the relationship between the blood Cu/Zn ratio and anemia in patients undergoing maintenance hemodialysis (MHD) treatment. This cross-sectional study included patients undergoing MHD at our center in September 2019. Clinical and demographic data and blood samples were collected before the hemodialysis sessions, and the blood levels of Zn and Cu were measured by inductively coupled plasma mass spectrometry. Multivariable linear and binary logistic regression analyses were performed to study the relationship between blood Cu/Zn ratio and anemia. A total of 144 MHD patients were enrolled in this study. The patients had a mean age of 64.33 ± 13.39 years, a median dialysis vintage of 33.50 (16.25–57.50) months, with 66 being females (45.8%). The median blood Cu/Zn ratio was 15.55 (interquartile range: 12.47–20.31). Anemia was present in 99 patients (68.8%). Groups with higher hemoglobin levels had decreased blood Cu/Zn ratios (p < 0.05). After adjustments for confounding factors, higher blood Cu/Zn ratios were independently associated with lower hemoglobin levels and anemia in MHD patients based on multivariate linear and multivariate binary logistic regression, respectively, in different models. Our study found that the blood Cu/Zn ratio is independently associated with anemia in MHD patients, but prospective multicenter studies with larger sample sizes are still needed to determine the appropriate cutoff values for blood zinc, blood copper, and blood Cu/Zn levels in this patient population.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors are thankful to all nurses in the hemodialysis center of Guangzhou Red Cross Hospital, Jinan University. We specially thank Shilin Xu, B.S.Nurse, because all the laboratory data in the study derived from the electronic management system for blood purification center (Hope®, software) are developed by him, which can import the laboratory test results according to the patients’ IDs included in the study.

Funding

This research was supported by 1 grant from the Science and Technology Planning Project of Guangdong Province, 2017B090904027, and 1 grant from the Guangzhou Clinically Characteristic Technology Project No. 2019TS60.

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Author notes

  1. Sujun Zuo and Mengmeng Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China

    Sujun Zuo, Mengmeng Liu, Yun Liu, Shilin Xu, Xiaoshi Zhong, Danping Qin & Yan Liu

  2. Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou City, Guangdong province, China

    Yun Liu, Jingxian Qiu, Rongshao Tan & Yan Liu

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  1. Sujun Zuo
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  2. Mengmeng Liu
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Contributions

S.Z contributed to the study design, partial data collection, and drafting of the manuscript; M.L was involved in the analysis and interpretation of the data; Y.L contributed to the study design; S.X and J.Q collected data and blood samples in every MHD patients; X.Z, D.Q, R.T, and Y.L were involved in the study design and critical revision of the manuscript for important intellectual content; and D.Q finally approved the submission of the manuscript.

Corresponding author

Correspondence to Danping Qin.

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This study (including all protocols) was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Guangzhou Red Cross Hospital, Jinan University Hospital (license code: 2019–235-01).

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Written informed consent was obtained from the individual or guardian participant.

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Zuo, S., Liu, M., Liu, Y. et al. Association Between the Blood Copper-Zinc (Cu/Zn) Ratio and Anemia in Patients Undergoing Maintenance Hemodialysis. Biol Trace Elem Res 200, 2629–2638 (2022). https://doi.org/10.1007/s12011-021-02888-8

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