Trace elements in end-stage renal disease. 2. Clinical implication of trace elements

For human beings trace elements are essential nutrients with a gamut of functions. They are for instance indispensable components of many enzymes, so they have some regulatory functions and they may affect immune reactions and free radical generation. Abnormalities of trace elements are primarily the result of uremia, and they may be further modified and sometimes greatly exacerbated by the dialysis procedure. The role of trace elements in hemodialysis (HD) patients has not yet been fully characterized. To prevent some complications in chronic HD patients, it is very important to regulate the levels of trace elements by adequate water treatment. Reverse osmosis is able to prevent the accumulation of the majority of trace elements in the patients. Zinc supplementation may be recommended for patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable. Selenium deficiency is to be suspected in dialyzed patients and selenium supplementation may be beneficial (increasing glutathione peroxidase activity, cardioprotective effect, immunostimulatory properties) for chronic renal failure patients. Supplementation with a trace element may be indicated when its depletion was unequivocally documented and when there is evidence of the positive effects of this element on the quality of life of the dialyzed patients.