{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:54:15Z","timestamp":1791575655793,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>\n                      We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. We used adjusted logistic regression to evaluate the association between trace element status and four outcomes (death, cardiovascular events, systemic infection, and hospitalization).\n                      <jats:italic toggle=\"yes\">A priori<\/jats:italic>\n                      hypotheses concerned (\n                      <jats:italic toggle=\"yes\">1<\/jats:italic>\n                      ) deficiency of zinc, selenium, and manganese and (\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      ) excess of lead, arsenic, and mercury. Concentrations of the other 19 elements were tested in hypothesis-generating analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over 2 years of follow-up, 260 (20%) patients died, 285 (24%) experienced a cardiovascular event, 117 (10%) were hospitalized for systemic infection, and 928 (77%) were hospitalized for any cause. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not independently associated with higher risk of clinical outcomes. Lower concentrations of selenium were strongly and independently associated with death (odds ratio, 0.86 per decile; 99.2% confidence interval, 0.80 to 0.93) and all-cause hospitalization (odds ratio, 0.92 per decile; 99.2% confidence interval, 0.86 to 0.98). In exploratory analyses, higher copper concentrations were significantly associated with higher risk of death (odds ratio, 1.07 per decile; 99.2% confidence interval, 1.00 to 1.15), and cadmium levels in the highest decile were associated with higher risk of death (odds ratio, 1.89; 99.2% confidence interval, 1.06 to 3.38).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower levels of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with higher risk of clinical outcomes, but lower concentrations of selenium were strongly and independently associated with the risks of death and hospitalization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.11451017","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T09:25:13Z","timestamp":1522315513000},"page":"907-915","source":"Crossref","is-referenced-by-count":76,"title":["Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients"],"prefix":"10.2215","volume":"13","author":[{"given":"Marcello","family":"Tonelli","sequence":"first","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aminu","family":"Bello","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine J.","family":"Field","sequence":"additional","affiliation":[{"name":"Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Gill","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda R.","family":"Hemmelgarn","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailash","family":"Jindal","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott W.","family":"Klarenbach","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braden J.","family":"Manns","sequence":"additional","affiliation":[{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Thadhani","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kinniburgh","sequence":"additional","affiliation":[{"name":"Physiology and Pharmacology, University of Calgary, Calgary, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Alberta Kidney Disease Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,3,29]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/j.1525-139X.2010.00746.x","article-title":"Trace element status in hemodialysis patients.","volume":"23","author":"Rucker","year":"2010","journal-title":"Semin Dial"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3109\/10408368909106590","article-title":"Aluminum and chronic renal failure: Sources, absorption, transport, and toxicity.","volume":"27","author":"Wills","year":"1989","journal-title":"Crit Rev Clin Lab Sci"},{"key":"B3-20230813","first-page":"123","article-title":"Aluminium intoxication in renal disease.","volume":"169","author":"Kerr","year":"1992","journal-title":"Ciba Found Symp"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1146\/annurev.me.29.020178.000521","article-title":"Dialysis encephalopathy syndrome.","volume":"29","author":"Alfrey","year":"1978","journal-title":"Annu Rev Med"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1056\/NEJM198707093170204","article-title":"Serum aluminum levels and erythrocyte dihydropteridine reductase activity in patients on hemodialysis.","volume":"317","author":"Altmann","year":"1987","journal-title":"N Engl J Med"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1056\/NEJM197601222940402","article-title":"The dialysis encephalopathy syndrome. Possible aluminum intoxication.","volume":"294","author":"Alfrey","year":"1976","journal-title":"N Engl J Med"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1159\/000014342","article-title":"Trace elements in hemodialysis and continuous ambulatory peritoneal dialysis patients.","volume":"16","author":"Zima","year":"1998","journal-title":"Blood Purif"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1159\/000014395","article-title":"Trace elements in end-stage renal disease. 2. Clinical implication of trace elements.","volume":"17","author":"Zima","year":"1999","journal-title":"Blood Purif"},{"issue":"Suppl 2","key":"B9-20230813","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/ndt\/11.supp2.92","article-title":"Adequacy of dialysis: Trace elements in dialysis fluids.","volume":"11","author":"D\u2019Haese","year":"1996","journal-title":"Nephrol Dial Transplant"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1741-7015-7-25","article-title":"Trace elements in hemodialysis patients: A systematic review and meta-analysis.","volume":"7","author":"Tonelli","year":"2009","journal-title":"BMC Med"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.clnu.2012.02.008","article-title":"Essential trace element status and clinical outcomes in long-term dialysis patients: A two-year prospective observational cohort study.","volume":"31","author":"Yang","year":"2012","journal-title":"Clin Nutr"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"3331","DOI":"10.1093\/ndt\/gfq859","article-title":"Serum selenium levels are inversely associated with death risk among hemodialysis patients.","volume":"26","author":"Fujishima","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.amjmed.2010.10.022","article-title":"Association of blood lead levels with mortality in patients on maintenance hemodialysis.","volume":"124","author":"Lin","year":"2011","journal-title":"Am J Med"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1471-2369-12-10","article-title":"Design and implementation of the Canadian Kidney Disease Cohort Study (CKDCS): A prospective observational study of incident hemodialysis patients.","volume":"12","author":"Bello","year":"2011","journal-title":"BMC Nephrol"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1053\/j.ajkd.2017.06.029","article-title":"Concentrations of trace elements in hemodialysis patients: A prospective cohort study.","volume":"70","author":"Tonelli","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12911-015-0155-5","article-title":"Methods for identifying 30 chronic conditions: Application to administrative data.","volume":"15","author":"Tonelli","year":"2015","journal-title":"BMC Med Inform Decis Mak"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0140-6736(00)02490-9","article-title":"The importance of selenium to human health.","volume":"356","author":"Rayman","year":"2000","journal-title":"Lancet"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3148\/66.2.2005.98","article-title":"The relevance of selenium to immunity, cancer, and infectious\/inflammatory diseases.","volume":"66","author":"Ryan-Harshman","year":"2005","journal-title":"Can J Diet Pract Res"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/978-94-007-7500-8_16","article-title":"Selenium. Role of the essential metalloid in health.","volume":"13","author":"Kurokawa","year":"2013","journal-title":"Met Ions Life Sci"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"340","DOI":"10.3390\/nu5020340","article-title":"Selenistasis: Epistatic effects of selenium on cardiovascular phenotype.","volume":"5","author":"Joseph","year":"2013","journal-title":"Nutrients"},{"key":"B22-20230813","doi-asserted-by":"crossref","first-page":"2076","DOI":"10.1093\/ajcn\/32.10.2076","article-title":"Selenium deficiency in total parenteral nutrition.","volume":"32","author":"van Rij","year":"1979","journal-title":"Am J Clin Nutr"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1093\/ndt\/gfs170","article-title":"Selenium supplementation improves the nutritional status of hemodialysis patients: A randomized, double-blind, placebo-controlled trial.","volume":"28","author":"Salehi","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s12882-015-0042-4","article-title":"Trace element supplementation in hemodialysis patients: A randomized controlled trial.","volume":"16","author":"Tonelli","year":"2015","journal-title":"BMC Nephrol"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"179","DOI":"10.15171\/jrip.2016.38","article-title":"Effect of selenium supplementation on lipid profile in hemodialysis patients.","volume":"5","author":"Omrani","year":"2016","journal-title":"J Renal Inj Prev"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s11255-012-0211-3","article-title":"Clinical factors associated with serum copper levels and potential effect of sevelamer in hemodialysis patients.","volume":"45","author":"Ikee","year":"2013","journal-title":"Int Urol Nephrol"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1017\/S000711451100376X","article-title":"Copper and iron in Alzheimer\u2019s disease: A systematic review and its dietary implications.","volume":"107","author":"Loef","year":"2012","journal-title":"Br J Nutr"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s11255-014-0689-y","article-title":"Dietary intake of trace elements, minerals, and vitamins of patients on chronic hemodialysis.","volume":"46","author":"Bossola","year":"2014","journal-title":"Int Urol Nephrol"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"266","DOI":"10.5301\/jn.5000213","article-title":"Selenium and kidney disease.","volume":"26","author":"Iglesias","year":"2013","journal-title":"J Nephrol"},{"key":"B32-20230813","first-page":"181","article-title":"Assessment of reference values for selected elements in a healthy urban population.","volume":"41","author":"Alimonti","year":"2005","journal-title":"Ann Ist Super Sanita"},{"key":"B33-20230813","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.forsciint.2005.04.020","article-title":"Metal and metalloid multi-elementary ICP-MS validation in whole blood, plasma, urine and hair. Reference values.","volume":"153","author":"Goull\u00e9","year":"2005","journal-title":"Forensic Sci Int"},{"key":"B34-20230813","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1093\/jat\/bkt046","article-title":"Metallic profile of whole blood and plasma in a series of 106 healthy volunteers.","volume":"37","author":"Cesbron","year":"2013","journal-title":"J Anal Toxicol"},{"key":"B35-20230813","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/0048-9697(90)90055-Y","article-title":"Trace element reference values in tissues from inhabitants of the European community. I. A study of 46 elements in urine, blood and serum of Italian subjects.","volume":"95","author":"Minoia","year":"1990","journal-title":"Sci Total Environ"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201806000-00014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:37:52Z","timestamp":1786369072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201806000-00014"}},"subtitle":["A Prospective Cohort Study"],"short-title":[],"issued":{"date-parts":[[2018,3,29]]},"references-count":33,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.11451017","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,29]]}}}