Serum Nickel Concentrations in Patients Receiving Chronic Hemodialysis

Chronic nickel accumulation is harmful to multiple organ systems, and nickel is classified as a human carcinogen. Nevertheless, few studies have examined serum nickel concentrations in end-stage kidney disease (ESKD) patients receiving chronic hemodialysis, and the relationship of serum nickel with clinical outcomes remains unclear.

This prospective observational study recruited 409 hemodialysis patients in 2019 and followed them for 18 months. The patients were stratified into four quartiles, that is, < 2.9 μg/L (n = 92), 2.9 μg/L to < 3.4 g/L (n = 104), 3.4 μg/L to < 3.9 μg/L (n = 104), and ≥ 3.9 μg/L (n = 109), according to their serum nickel concentrations. Baseline demographic, hematologic, biochemical, dialysis-related, and mortality data were obtained for analysis.

The mean age of the patients was 62.9 ± 11.7 years. A total of 401 (98.04%) patients had elevated serum nickel concentrations, with an average level of 3.6 ± 1.3 μg/L. Higher quartiles of serum nickel were associated with longer dialysis vintage (p < 0.001), higher Kt/V values (p < 0.001), and higher urea removal rates (p < 0.001). Multivariate analysis identified albumin level and dialysis vintage as independent factors positively correlated with serum nickel concentrations (R = 0.163, p = 0.001; R = 0.212, p < 0.001, respectively). Nevertheless, no association was found between serum nickel levels and all-cause mortality.

ESKD patients on hemodialysis commonly exhibit elevated serum nickel concentrations, possibly linked to serum albumin levels and dialysis vintage. Further studies are warranted.