Open AccessEffect of zinc deficiency on chronic kidney disease progression and effect modification by hypoalbuminemia
Author(s) -
Atsuyuki Tokuyama,
Eiichiro Kanda,
Seiji Itano,
Megumi Kondo,
Yasaku Wada,
Hiroyuki Kadoya,
Kengo Kidokoro,
Hajime Nagasu,
Tatsuya Sasaki,
Naoki Kashihara
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0251554
Subject(s) - hypoalbuminemia , kidney disease , hazard ratio , medicine , zinc , proportional hazards model , confidence interval , gastroenterology , zinc deficiency (plant disorder) , incidence (geometry) , risk factor , micronutrient , chemistry , pathology , physics , organic chemistry , optics
Serum zinc (Zn) levels tend to be low in chronic kidney disease (CKD) patients. This cohort study was conducted to investigate the relationship between zinc deficiency and CKD progression. Patients were classified into two groups based on Zn levels < 60 μg/dl (low-Zn group, n = 160) and ≥ 60 μg/dl (high-Zn group, n = 152). The primary outcome was defined as end-stage kidney disease (ESKD) or death and was examined over a 1-year observation period. Overall, the mean Zn level was 59.6 μg/dl and the median eGFR was 20.3 ml/min/1.73 m 2 . The incidence of the primary outcome was higher in the low-Zn group ( p <0.001). Various Cox proportional hazards models adjusted for baseline characteristics showed higher risks of the primary outcome in the low-Zn group than in the high-Zn group. Competing risks analysis showed that low Zn levels were associated with ESKD but not with death. Moreover, in propensity score-matched analysis, the low-Zn group showed a higher risk of the primary outcome [adjusted hazard ratio 1.81 (95% confidence interval 1.02, 3.24)]. Furthermore, an interaction was observed between Zn and serum albumin levels (interaction p = 0.026). The results of this study indicate that zinc deficiency is a risk factor for CKD progression.