LAUSR

Hypozincemia can arise in patients with advanced chronic kidney disease (CKD) due to low protein intake and urinary or dialytic loss. Several studies have confirmed an association between hypozincemia and infection. Because infections comprise a major complication in patients with advanced CKD, we investigated whether hypozincemia is associated with infection risk in incident patients on dialysis. We prospectively analyzed 380 consecutive patients aged 20 years old or more who started hemodialysis between January 2013 and December 2018. Six patients who were receiving zinc supplementation at the time of the study were excluded. Serum zinc values were obtained at the time of dialysis initiation. We followed up the remaining patients after enrollment. The endpoint was severe infection defined as infection-related death or bacteremia confirmed by the detection of microorganisms in two sets of culture bottles. The patients were equally divided into groups with low, middle or high serum zinc concentrations. Data were analyzed using Kaplan-Meier curves and Cox hazards models. The local ethics committee approved this research. Informed consent was obtained from each individual participant included in the study. The rate of severe infection events over a follow-up of one year was the highest in the group with low zinc (p = 0.030). Cox hazards models adjusted for age, sex, diabetes mellitus, serum albumin and serum zinc, selected hypozincemia as an independent risk factor for severe infection events (HR, 10.76; 95% CI, 1.28–90.41; p = 0.029). Hypozincemia is associated with risk of subsequent severe infection in incident patients on dialysis.