Trace Elements in Chronic Haemodialysis Patients and Healthy Individuals-A Comparative Study

Lokesh Shanmugam; Siva Ranganathan Green; Hemachandar Radhakrishnan; Tony Mathew Kadavanu; Arunkumar Ramachandrappa; Shashank Rakesh Tiwari; Amirtha Lakshmi Rajkumar; Ezhumalai Govindasamy

doi:10.7860/JCDR/2016/22031.8618

Trace Elements in Chronic Haemodialysis Patients and Healthy Individuals-A Comparative Study

J Clin Diagn Res. 2016 Oct;10(10):OC14-OC17. doi: 10.7860/JCDR/2016/22031.8618. Epub 2016 Oct 1.

Authors

Lokesh Shanmugam¹, Siva Ranganathan Green², Hemachandar Radhakrishnan³, Tony Mathew Kadavanu², Arunkumar Ramachandrappa⁴, Shashank Rakesh Tiwari⁵, Amirtha Lakshmi Rajkumar⁵, Ezhumalai Govindasamy⁶

Affiliations

¹ Associate Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
² Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
³ Associate Professor, Department of Nephrology, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
⁴ Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute , SBV University, Puducherry, India .
⁵ Resident, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
⁶ Senior Statistician and Research Consultant, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .

Abstract

Introduction: End Stage Renal Disease (ESRD) patients despite receiving adequate Haemodialysis (HD) develop significant risk of Cardiovascular Disease (CVD). Abnormality in levels of trace elements may potentiate vascular injury by producing sustained inflammation and endothelial dysfunction. Hence, the present study was undertaken to evaluate the levels of trace elements in patients receiving HD.

Aim: To study the blood levels of arsenic, cadmium, mercury, lead, chromium, barium, cobalt, caesium and selenium among ESRD patients undergoing HD and compare it with healthy individuals.

Materials and methods: It was a cross-sectional, comparative study done in a tertiary care center. About 40 established ESRD patients aged above 18 years, belonging to both sexes, undergoing chronic HD for more than six months were enrolled as Group A (Cases). Patients who had history of smoking and occupational exposure to heavy metals were excluded from the study. About 40 age and sex matched apparently healthy individuals attending health check-up were enrolled as Group B (Controls). Participants of this group had normal e-GFR by Modification of Diet in Renal Disease (MDRD) equation. About 5ml of fasting venous blood sample was obtained from both groups and analyzed for trace elements. Chi-square/Fisher's-exact test was used for comparing ratios. A p-value of <0.05 was considered statistically significant.

Results: In the present study, the mean blood levels of arsenic, cadmium, chromium and cobalt was found to be significantly higher in Group A as compared to Group B with all these parameters attaining a p-value of <0.001. Similarly, the mean blood levels of lead and caesium was high in Group A with a p-value of 0.001 each. The blood levels of mercury and barium did not vary significantly between both the groups with p=0.656 and 0.096 respectively. The blood levels of anti-oxidant selenium was lower in Group A, but did not attain statistical significance (p=0.217).

Conclusion: The mean blood levels of toxic trace elements were significantly elevated with a simultaneous reduction in essential trace elements in patients receiving HD, which probably may contribute to an increase in CVD.

Keywords: Endothelial dysfunction; Inflammation; Toxic elements.