Clinical and experimental nephrology · 2026
Zinc deficiency is associated with erythropoietin-stimulating agents hyporesponsive anemia in peritoneal dialysis patients: a cross-sectional study.
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Kuwahara Fumiko, Harada Kenji, Nagata Masaharu, Nakano Toshiaki, Ago Tetsuro, Kanai Hidetoshi
Аннотация
BACKGROUND: Zinc deficiency is widely recognized as a cause of anemia, but no studies have clarified the impact of zinc deficiency on achieving target hemoglobin levels in patients undergoing peritoneal dialysis (PD) and receiving high-dose erythropoiesis-stimulating agent (ESA) therapy. This study aimed to investigate the relationship between zinc deficiency and ESA-hyporesponsive anemia in patients on PD.
METHODS: This cross-sectional study included 164 patients on PD aged ≥ 18 years. The target hemoglobin level was 11-13 g/dL. ESA dosage was categorized as low-dose (< 120 µg/month) or high-dose (≥ 120 µg/month), while zinc deficiency was defined as a serum zinc level < 60 µg/dL. A logistic regression model was used to calculate the odds ratio (OR) for achieving the target hemoglobin level.
RESULTS: The proportion of patients achieving the target hemoglobin level was 48.2% in the low-dose ESA and non-zinc-deficient group, and 12.2% in the high-dose ESA and zinc-deficient group. Compared with the low-dose ESA and non-zinc-deficient group, the adjusted OR for achieving the target hemoglobin level was significantly lower in the high-dose ESA and zinc-deficient group (OR: 0.19, 95% confidence interval 0.05-0.72). Stratified analyses based on serum albumin, serum C-reactive protein, and transferrin saturation did not change the association between the high-dose ESA and zinc-deficient group and the achievement of the target hemoglobin level.
CONCLUSION: Zinc deficiency in patients on PD is a significant barrier to achieving the target hemoglobin level, and serum zinc levels should be routinely monitored in patients with ESA-hyporesponsive anemia.
METHODS: This cross-sectional study included 164 patients on PD aged ≥ 18 years. The target hemoglobin level was 11-13 g/dL. ESA dosage was categorized as low-dose (< 120 µg/month) or high-dose (≥ 120 µg/month), while zinc deficiency was defined as a serum zinc level < 60 µg/dL. A logistic regression model was used to calculate the odds ratio (OR) for achieving the target hemoglobin level.
RESULTS: The proportion of patients achieving the target hemoglobin level was 48.2% in the low-dose ESA and non-zinc-deficient group, and 12.2% in the high-dose ESA and zinc-deficient group. Compared with the low-dose ESA and non-zinc-deficient group, the adjusted OR for achieving the target hemoglobin level was significantly lower in the high-dose ESA and zinc-deficient group (OR: 0.19, 95% confidence interval 0.05-0.72). Stratified analyses based on serum albumin, serum C-reactive protein, and transferrin saturation did not change the association between the high-dose ESA and zinc-deficient group and the achievement of the target hemoglobin level.
CONCLUSION: Zinc deficiency in patients on PD is a significant barrier to achieving the target hemoglobin level, and serum zinc levels should be routinely monitored in patients with ESA-hyporesponsive anemia.