Patients with CKD, zinc deficiency at ‘high risk’ for infection-related hospitalizations
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For patients with advanced chronic kidney disease, low serum zinc concentration was linked to an increased likelihood of hospitalizations due to infections. This elevated risk was especially high for individuals on proton pump inhibitors.
“A [zinc] Zn deficiency is common in patients with chronic kidney disease (CKD) due to decreased absorption from the gastrointestinal tract, poor oral intake and urinary Zn loss,” Yosuke Saka, MD, PhD, of the department of nephrology at Kasugai Municipal Hospital in Japan, and colleagues wrote. “Although anemia in CKD has been clinically investigated, whether a Zn deficiency predicts clinical events including infections in patients with CKD remains obscure.”
As infections often confer poor outcomes for this patient population (including hospitalizations and mortality), the researchers contended it is “critically important” to gain a better understanding of the factors associated with infections and to develop prevention strategies.
For the study, researchers included 299 patients with CKD who had serum zinc levels measured during anemia evaluations (46% were on maintenance dialysis). Patients were categorized as having low (defined as 50 ug per dL or less) or high (greater than 50 ug per dL) zinc values. Researchers emphasized that zinc levels were “very low” in approximately 80% of the study population.
After a median follow-up of 36 months, 40 patients experienced an infection-related hospitalization (infections included respiratory, soft tissue, abdominal, bacteremia, urinary tract, and bone and joint).
Results showed patients with low zinc values had higher overall rates of hospitalization due to infections than those with greater values (23.3% vs. 12.6%), as well as higher rates of long-term hospitalizations (defined as more than 10 days; 26.2% vs. 12.4%).
Further findings indicated lower zinc levels remained an independent risk factor for infection-related hospitalizations even after adjustments were made for older age (70 years or older) and low physical function.
The elevated risk for hospitalization with low serum zinc was most pronounced for patients who were currently on proton pump inhibitors, according to the researchers (hazard ratio = 2.66).
“Notably, the serum Zn value was closely associated with infection events in patients medicated with [proton pump inhibitors] PPI,” Saka and colleagues wrote. “Two studies have shown that changes in intragastric pH caused by long-term PPI medication interfere with the absorption of micronutrients, including Zn. We speculate that a PPI-induced Zn deficiency increases the risk of infection events in patients with advanced CKD ... Identifying factors that influence infectious diseases is essential, because infections are the cause of major complications in patients with CKD.”
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