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Principles responsible for trace element concentrations in chronic kidney disease.
Clinical Nephrology
|May 7, 2021
Summary
Trace element levels change significantly in chronic kidney disease (CKD). Some elements are lost, while others build up, impacting patient health and requiring further research for better monitoring guidelines.
Area of Science:
- Nephrology
- Clinical Chemistry
- Trace Element Metabolism
Background:
- Trace element derangements are common in renal failure and critical in chronic kidney disease (CKD).
- The natural history of trace element deposition in worsening CKD is poorly understood.
- Essential trace elements like selenium, zinc, and manganese may be lost, while others such as cobalt, lead, molybdenum, and vanadium can accumulate.
Purpose of the Study:
- To synthesize available data on trace element absorption, elimination, distribution, protein binding, and proteinuria in CKD.
- To summarize existing literature and identify research gaps regarding trace element metabolism in CKD.
- To enable prediction of trace element behavior in clinical scenarios lacking direct observational data.
Main Methods:
- Literature synthesis of existing data on trace element pharmacokinetics (absorption, elimination, distribution, protein binding).
- Analysis of proteinuria's role in trace element changes.
- Review of data primarily from hemodialysis patients, noting gaps in other CKD populations.
Main Results:
- Data are most comprehensive for hemodialysis patients, with less information available for continuous renal replacement therapies and non-dialysis CKD patients.
- Specific trace elements show differential behavior: some are wasted (Se, Zn, Mn), others accumulate (Co, Pb, Mo, V).
- Understanding absorption, elimination, and distribution is key to predicting trace element fate.
Conclusions:
- Further prospective studies are needed to investigate the impact of abnormal trace elements in CKD.
- The therapeutic value of trace element interventions requires evaluation.
- Current Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines for trace element monitoring may need enhancement based on new evidence.
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