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Nutrients 2017, 9(11), 1177; doi:10.3390/nu9111177

Altered Metabolism of Blood Manganese Is Associated with Low Levels of Hemoglobin in Patients with Chronic Kidney Disease

1
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul 06591, Republic of Korea
2
Division of Nephrology, Yeouido St. Mary’s Hospital, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea
3
Division of Nephrology and Hypertension, Department of Medicine, School of Medicine, Vanderbilt University, S3206 Medical Center North, Nashville, TN 37232-2372, USA
4
Division of Nephrology, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon 21431, Republic of Korea
*
Author to whom correspondence should be addressed.
Received: 22 August 2017 / Revised: 23 October 2017 / Accepted: 24 October 2017 / Published: 27 October 2017
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Abstract

Blood manganese (Mn) level has been reported to be higher in patients with anemia or iron deficiency. The purpose of this study was to analyze the relationship between blood Mn level and anemia in patients with chronic kidney disease (CKD). A total of 334 patients with CKD who were not treated with dialysis were included in this study. Blood Mn level and serum markers regarding anemia, renal function, and nutrition were measured and analyzed. Median blood Mn level was 8.30 (interquartile range(IQR): 5.27–11.63) μg/L. Univariate linear regression showed that blood Mn level was correlated with age (β = −0.049, p < 0.001), smoking (β = −1.588, p = 0.009), hypertension (β = −1.470, p = 0.006), serum total iron-binding capacity (TIBC) (β = 0.025, p < 0.001), serum transferrin (β = 0.029, p < 0.001), and estimated glomerular filtration rate (eGFR; β = 0.036, p < 0.001). Results of multiple linear regression analysis showed that beta coefficient of hemoglobin was 0.847 (p < 0.001) for blood Mn level in all participants after controlling for covariates, including gender, age, body mass index, smoking, diabetes, hypertension, and eGFR. Multivariate Poisson regression analysis with robust variance after adjusting for gender, age, smoking, hypertension, diabetes, eGFR, and nutritional markers showed that higher blood Mn level (per 1 μg/L increase) was associated with decreased prevalence of anemia (PR 0.974, 95% CI: 0.957 to 0.992, p = 0.005). Taken together, our results demonstrate that blood Mn level is positively associated with hemoglobin level in CKD patients. This might provide important information in the understanding of the pathogenesis of CKD-related anemia. View Full-Text
Keywords: manganese; anemia; chronic kidney disease manganese; anemia; chronic kidney disease
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MDPI and ACS Style

Kim, M.; Koh, E.S.; Chung, S.; Chang, Y.S.; Shin, S.J. Altered Metabolism of Blood Manganese Is Associated with Low Levels of Hemoglobin in Patients with Chronic Kidney Disease. Nutrients 2017, 9, 1177.

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