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Nutrients 2015, 7(5), 3783-3795; doi:10.3390/nu7053783

Oral Zinc Supplementation Reduces the Erythropoietin Responsiveness Index in Patients on Hemodialysis

Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-chou, Itabashi-ku, Tokyo 173-8610, Japan
Department of Nephrology, Meirikai Chuo General Hospital, 3-2-11, Higashijujou, Kita-ku, 114-0001 Tokyo, Japan
Department of Nephrology, Keiai Hospital, 3-10-6, Mukaihara, Itabashi-ku, 173-0036 Tokyo, Japan
Author to whom correspondence should be addressed.
Received: 4 April 2015 / Revised: 27 April 2015 / Accepted: 8 May 2015 / Published: 15 May 2015
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Background: In hemodialysis (HD) patients, zinc depletion caused by inadequate intake, malabsorption, and removal by HD treatment leads to erythropoiesis-stimulating agent (ESA) hyporesponsiveness. This study investigated the effects of zinc supplementation in HD patients with zinc deficiency on changes in the erythropoietin responsiveness index (ERI). Methods: Patients on HD with low serum zinc levels (<65 μg/dL) were randomly assigned to two groups: The polaprezinc group (who received daily polaprezinc, containing 34 mg/day of zinc) (n = 35) and the control group (no supplementation) (n = 35) for 12 months. All the 70 patients had been taking epoetin alpha as treatment for renal anemia. ERI was measured with the following equation: Weekly ESA dose (units)/dry weight (kg)/hemoglobin (g/dL). Results: There were no significant changes in hemoglobin levels within groups or between the control and polaprezinc groups during the study period. Although reticulocyte counts were increased immediately after zinc supplementation, this change was transient. Serum zinc levels were significantly increased and serum copper levels were significantly decreased in the polaprezinc group after three months; this persisted throughout the study period. Although there was no significant change in the serum iron or transferrin saturation levels in the polaprezinc group during the study period, serum ferritin levels significantly decreased following polaprezinc treatment. Further, in the polaprezinc group, ESA dosage and ERI were significantly decreased at 10 months and nine months, respectively, as compared with the baseline value. Multiple stepwise regression analysis revealed that the change in the serum zinc level was an independent predictor of lowered ERI. Conclusions: Zinc supplementation reduces ERI in patients undergoing HD and may be a novel therapeutic strategy for patients with renal anemia and low serum zinc levels. View Full-Text
Keywords: erythropoietin responsiveness index; erythropoiesis stimulating agent; hemodialysis; renal anemia; zinc deficiency erythropoietin responsiveness index; erythropoiesis stimulating agent; hemodialysis; renal anemia; zinc deficiency

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Kobayashi, H.; Abe, M.; Okada, K.; Tei, R.; Maruyama, N.; Kikuchi, F.; Higuchi, T.; Soma, M. Oral Zinc Supplementation Reduces the Erythropoietin Responsiveness Index in Patients on Hemodialysis. Nutrients 2015, 7, 3783-3795.

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