Lower Levels of Blood Zinc Associated with Intradialytic Hypertension in Maintenance Hemodialysis Patients
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Lower Levels of Blood Zinc Associated with Intradialytic Hypertension in Maintenance Hemodialysis Patients Yun Liu 1,2 & Yuanyuan Zheng 1 & Liangtao Wang 1 & Xiaoshi Zhong 1 & Danping Qin 1 & Wenxuan Chen 1 & Rongshao Tan 2 & Yan Liu 1,2 Received: 10 June 2020 / Accepted: 9 September 2020 # The Author(s) 2020
Abstract Intradialytic hypertension (iHTN) has been related with an increased risk of mortality, with imbalances in trace elements being frequent in maintenance hemodialysis (MHD) patients. The aim of this study was to analyze the relationships between the levels of blood trace elements and iHTN in MHD patients. A total of 144 MHD patients were enrolled in September, 2019 (66 females; 5616 hemodialysis treatments), with a mean age of 64.33 ± 13.39 years and median vintage of 33.50 (16.25–57.50) months. Patients exhibited an average peridialytic systolic blood pressure (SBP) change of − 4.18 ± 20.22 mm Hg in the next 3 months. Thirty-four (23.6%) patients had persistent iHTN (piHTN). These patients were characterized by older age, higher rate of hypozincemia, and modified Charlson comorbidity score, whereas lower blood zinc and hemoglobin, at the time of their recruitment. No significant difference in the levels of other blood trace elements was observed between groups. A general linear mixed (GLM) model showed that with every mg/L point lower mean blood zinc at baseline, the peridialytic SBP change was increased by 4.524 mm Hg (P < 0.001). Binary logistic model in modulate of the GLM model revealed that the lower level of blood zinc was associated with piHTN (OR = 0.433, 95 % CI 0.295 to 0.637, P < 0.001). Multivariate analysis confirmed both above results. Our study indicated that lower blood zinc was independently associated with piHTN in patients undergoing MHD, but prospective studies with larger population are still needed. Keywords Blood zinc . Intradialytic hypertension . Maintenance hemodialysis . Trace elements . Hypozincemia
Introduction Although hemodialysis (HD) is known to promote a reduction in the levels of blood pressure (BP) in most hypertensive patients, because of the removal of fluids and salt [1], a minority of patients have been shown to regularly exhibit a paradoxical increase either toward or at the end of HD [2]. This phenomenon has been termed intradialytic hypertension (iHTN). There is no consensus regarding its definition, but clinical studies have recently reported iHTN during HD as a rise in the systolic blood pressure (SBP) greater than 10 mm Hg Yun Liu and Yuanyuan Zheng contributed equally to this work. * Rongshao Tan [email protected] 1
Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou, China
2
Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou, China
above the level of predialysis SBP [3–5]. Results from cohort studies with a larger sample size showed that 8–13% of HD patients had iHTN [2, 5]. Compared with pati
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