Trace Element Status in Pediatric Patients on Regular Hemodialysis

Abstract

Trace elements, which have a crucial role in metabolism and enzymatic pathways, are not routinely monitored in the blood of pediatric patients with chronic kidney disease. In renal insufficiency, trace elements metabolism can be affected with the reduced renal function, alteration of metabolic balance, special diet, medications, and dialysis treatment. Various trace elements abnormalities in long term hemodialysis patients have been reported. These disturbances are influenced by the direction and rate of the elements transfer during dialysis procedure, which depends on their concentrations in the dialysis fluid. The objectives of our study was to assess the effect of regular hemodialysis on the concentrations of some trace elements in pediatric patients and to assess whether regular hemodialysis pediatric patients need replacement or elimination therapy of these trace elements. To obtain these objectives, we included 60 pediatric patients on regular hemodialysis attending nephrology unit in children's hospital, Ain Shams University and 60 age and sex matched apparently healthy children in our study. As regard to demographic data, our study revealed that the prevalence of CKD in our patients was higher in males (53.3%) than in females (46.7%). Male preponderance may be explained by higher prevalence of CAKUT (40%) in our study which is generally common in boys. Our study showed that there was a significant decrease in the serum copper & lead levels in patients compared to controls. Also, we found that gender has no effect on trace elements blood levels. A significant positive correlation between cadmium and age of our patients was noticed, but the duration of hemodialysis showed no significance on trace elements blood levels. We found a negative correlation between lead level and BMI in our patients. In a trial to find the effect of trace elements on iron status, a significant negative correlation between copper and ferritin level was found. Regarding trace element effects on lipid status in hemodialysis patients, a significant positive correlation between blood copper and cholesterol levels was found, while there was a significant negative correlation between cadmium and triglycerides. Regarding the effect of trace elements on metabolic bone status, blood lead level & PTH showed a significant positive correlation, while it was negative with zinc. Manganese and Po4 had a positive correlation, while a negative one was observed between blood cadmium and calcium levels.