|Year : 2023 | Volume
| Issue : 1 | Page : 118-122
Changes in the level of zinc and copper and some biochemical parameters in patients with chronic kidney failure
Omar Mohamed Hameed1, Sukayna Hussain Rashed2, Luay Abed Al-Helaly2
1 Department of Medical Laboratories, AL-Noor University College, Bartella, Iraq
2 Department of Chemistry, College of Science University of Mosul, Mosul, Iraq
|Date of Submission||17-Nov-2022|
|Date of Decision||08-Feb-2023|
|Date of Acceptance||27-Feb-2023|
|Date of Web Publication||14-Mar-2023|
Sukayna Hussain Rashed
Department of Chemistry, College of Science University of Mosul, Mosul
Source of Support: None, Conflict of Interest: None
Background: Chronic kidney failure (CRF) is characterized by a progressive loss of functional status over weeks or months, which may result in one of the illness's recognized consequences, such as cardiovascular disease, chest pain, or anemia. CRF has been generally understood as a worldwide public health problem and a big factor to death and morbidity during the previous decade. Methods: Determination of zinc and copper, urea, creatinine, total protein, globulin, alanine aminotransferase (ALT), albumin, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) in (CRF) Iraqi patients. This study included (40) patients and (38) healthy subjects as control. Samples were collected from January to April (2022). The biochemical parameters were determined using spectrophotometrically, but zinc and copper were determined by atomic absorption spectrophotometer. Results: Copper, urea, creatinine, ALP, AST, ALT, and LDH were significantly higher in CRF patients, whereas zinc, total protein, albumin, and globulin were lower in CRF patients as compared with control. The research also concerned study the relation between sex (male and female) and biochemical parameters which showed significant differences in comparison male of patients with males of control, yet globulin showed nonsignificant differences. While patients and control females showed nonsignificant differences. Conclusions: LDH in CRF patients might be used as a biomarker to detect renal dysfunction in dialysis patients at an early point, and blood serum Zn deficit in CRF. Furthermore, a relationship among Zn and albumin amounts was discovered. As a result, Zn and copper in CRF, particularly hypoalbuminemia, must be frequently evaluated and adjusted.
Keywords: Alanine aminotransferase, aspartate aminotransferase, CKF, copper, lactate dehydrogenase, zinc
|How to cite this article:|
Hameed OM, Rashed SH, Al-Helaly LA. Changes in the level of zinc and copper and some biochemical parameters in patients with chronic kidney failure. Biomed Biotechnol Res J 2023;7:118-22
|How to cite this URL:|
Hameed OM, Rashed SH, Al-Helaly LA. Changes in the level of zinc and copper and some biochemical parameters in patients with chronic kidney failure. Biomed Biotechnol Res J [serial online] 2023 [cited 2023 Mar 28];7:118-22. Available from: https://www.bmbtrj.org/text.asp?2023/7/1/118/371688
| Introduction|| |
Chronic kidney illness or failure (CRF) is characterized by a progressive loss of functional status over weeks or months, which may result in one of the illness's recognized consequences, such as cardiovascular disease, sharp chest pain, or anemia. CRF has been generally understood as a worldwide public health problem and a big factor to death and morbidity during the previous decade., End-stage kidney disease is renowned to associated with CRF. Hemodialysis is a way of removing waste from the body. When the kidneys are in renal disease, the kidney transplant device eliminates waste such as creatine, ammonia, and plasma liquid.
Zinc (Zn) is a trace mineral that is engaged in a variety of physiological actions in the organism. It is necessary for cell viability, development, and multiplication, as well as the stimulation of 300 or even more enzyme. As a building element of several proteins, also helps to a broad range of biological processes, include proteins contributory in DNA synthesis and signaling passage, alongside transcriptional., Any disruptions in Zn balance may affect immunological function, development, perceptual, and metabolism., Patients on hemofrequently acquire Zn insufficiency as a result of Zn loss after hemodialysis, insufficient dietary intake, and malabsorption. Earlier research found that Zn well-being and mental health are the responsiveness to erythropoietin treatment in dialysis patients. Zn therapy 15–24 pathological alterations associated with renal loss and proximal tubular disease in diabetic rats. A prior clinical trial found that Zn supplementation reduced urine albumin production in type 2 diabetic patients with nephropathy. These findings imply that the Zn supplement may prevent the development of renal impairment.
Albumin comprises the most prevalent plasma volume protein generated in the brain, accounting for a sizeable portion of all plasma. It accounts for about 60% points of blood serum proteins and is predominantly generated by hepatocellular hepatocytes, with the exception of early in fetal development, where it is mainly synthesized by the yolk.,
High everyday copper consumption may produce metal deposition in the kidneys and induce renal toxicity, which is characterized by distal tube atrophy caused by oxidative stress and cellular damage and results in a loss in creatinine. Nevertheless, the interaction among copper and renal illness is unidirectional, since aberrations in the balance of circulatory copper ions may emerge in individuals with chronic kidney impairment due to reduced renal excretion and alterations in protein digestion. In fact, regulating plasma copper amounts in renal failure patients is critical for avoiding problems. Previous research has linked higher circulating copper levels to chronic renal illness.
Progressive kidney diseases were selected because of their influence on essential minerals (Zn and copper) as well as physiological factors such as urea, creatine, protein content, protein, nucleate, alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH)., A huge proportion of individuals die from renal failure in most regions of the globe where dialysis or transplants are not accessible or are too costly. This makes research into serum biomarkers for soon (early) identification of kidney failure not only beneficial but also critical. Preventing CRF progression is an essential method for improving bad progression and avoiding a decline in quality of life. As a result, we undertook this investigation to determine if the laboratory tests investigated are risk factors for the emergence of CKF.
| Methods|| |
Reagents and methodology
The cathering of patient sample
This research comprised 78 blood specimens at Nineveh City Centers in Iraq, from January to April (2022). One plasma sample has been taken after all subjects provided informed permission. The samples were belonged to 40 sick and 38 normal men and women ranging in age between 30 and 57 years.
Ethical approval consideration
Before asking them to sign a written consent form, the subjects in this study were given a thorough explanation of the study's objectives. After that, a thorough questionnaire was used to collect the subjects' medical histories and other personal information. The ethical permission for this study was given by the Nineveh Health Department in Iraq on December 16, 2021, under reference number 167.
Criterion for inclusion and exclusion
Criterion for inclusion
This study included (40) patients ranging in their age between 30 and 65 years and (38) healthy subjects 30–57 years as control.
Criteria for exclusion
Participants outside the age range of 30–65 years old, as well as those with established pathologies including cancer, hepatitis, hypertension, or heart disease, were excluded from the study. The controls as well as the subjects were both exposed to the same exclusion criteria.
Specimen capture and keeping
Each participant underwent a 7-ml venous blood draw after an 8–12 h fast. Two milliliters of this blood was then dispersed into a plain vial and allowed to clot. To determine the total protein content, serum was drawn from the blood and centrifuged for 5 min at 3000 g/min. For additional estimations, 3 ml of venous blood was dispensed into an ethylenediaminetetraacetic acid container.
Measured the examined variables
Biolabo/France provided a kit for quantifying urea, albumin, total protein, ALP, AST, ALT, and LDH in human serum. They followed the operating manual for determining globulin, whereas albumin was calculated using the formula given by Iseki et al.
The zinc and copper had been evaluated after diluting the blood serum to ion-free water at a ratio of 5:1 for each of the elements zinc and copper utilizing light waves of 213.9 and 324.8 nm, including both, but use an elemental analysis device of the type (Perkin Elmer 403 Atomic emission spectrometer). They were given standard curves based on the established stock solution for each element part.
To eliminate input mistakes, data were coded into Excel Spreadsheets using customized Excel forms and analyzed using the Statistical SPSS package version 22 (IBM SPSS statistics, Armonk, New York, USA). The average and standard deviation were used to represent all values. To compare the averages of biochemical variables, the paired t-test was performed. When the possibility (P) was P ≤ 0.05, the changes were judged significant.
| Results|| |
In the present study, we found that the increase in plasma metals, ammonia, ALP, AST, ALT, and LDH tiers both in males and females at P ≤ 0.05 in persistent renal insufficiency groups diagnosed to one's concurrent normal controls organizations, but a sharp reduction in zinc, protein content, total protein, as well as fibrinogen tiers in CKF patient populations, especially in comparison to normal control.
The average creatinine level was 5.34 mg/dL. The average urea level was 144.2 mg/dL. Their serum concentration LDH level was 456.2 IU/L, with a low serum LDH of 442.32 IU/L, and a high serum LDH of 470.08 IU/L. The mean serum total protein level was 5.4 g/dL, the mean ALT level was 22.72 IU/L, and the mean AST level was 29.32 IU/L [Table 1].
|Table 1: Comparison of zinc and copper levels, as well as other biochemical variables, in the control and CKF groups|
Click here to view
While the results shown in [Table 2] and [Table 3] indicated a significant decrease in the level of zinc for males and females of illness by chronic offal letdown likened to the governor group for males and females at 0.0001. There is no significant difference in females with kidney deficiency. As for copper, its value in males is less than in the control group we notice an important decrease in the value of copper in male patients associated to females (0.0001). In addition, it is noted that the value of zinc and copper in males differs from females in the control group and that their values in females are less than in males.
|Table 2: Biochemical variable levels in men were compared between the control group and the group of patients with chronic renal failure|
Click here to view
|Table 3: Biochemical variable levels in the control and chronic renal failure groups in females|
Click here to view
There was also a connection among zinc and protein levels, findings showed that hypoalbuminemia may hasten the onset of CRF caused by zinc deficiency.
| Discussion|| |
Renal disease is a serious public health concern across the globe, with just an increasing rate and incidence that promises to become a true pandemic. Because the zinc fingers and homeobox transcriptionally family is widely expressed in pericytes, these factors have a role in renal illness. Serum zinc levels tend to fall as CRF progresses and are higher in individuals on continuous hemodialysis.,
These results are consistent with what the researcher stated the reason is attributed to the breakdown of renal tissue cells and the inability of the kidney to perform its function to remove toxic substances from urea and creatinine. It may be due to the lack of zinc in the body, therefore, to the lack of total protein, albumin, and globulin that binds with them, as zinc plays an important role in building protein. In addition, it is noted that the value of zinc and copper in males differs from females in the control group and this is consistent with what the researchers said and that their value in females is less than in males, which agrees with the researchers. In prior research, men had greater serum zinc concentrations than females. Those data are related to the findings of our investigation. Furthermore, serum zinc deficit in renal patients has indeed been documented as a result of suffers due, tube reabsorption impairments, nephritis, and C-reactive insufficiency, which is involved in zinc intestine uptake. Across both kids and adults, hypoxemia is frequent in CRF and is related with a rise in disease.,
The findings revealed that zinc deficiency is a risk factor for end-stage renal disease. The process behind the link among vitamin deficiency with renal impairment, though, remains unknown. Several basic investigations have indicated that zinc is an oxidative stress regulator., Zinc is a super oxidant cofactor with antioxidant capacity, and it helps to reduce peroxidation. Furthermore, zinc deficiency has been linked to oxidative stress and kidney damage through the enzyme NAD+oxidase (NADPH). A significant amount of research suggests that chronic damage is the common factor for the primary mechanisms implicated in kidney disease development. In kidney illness, NADPH dehydrogenase has been recognized as a key cause of oxidative stress.,
While LDH has been shown to be useful in diagnosing heart attack, its extensive dispersion in the body limits its accuracy. Chen et al. investigated variations in LDH activity in renal disorders in 1991. They observed that LDH had a positive association with plasma protein in the urine (blood urea nitrogen) but no link with plasma creatinine levels despite the fact that the investigation was specifically for kidney illness.,
Adanho et al. have previously examined the content of LDH isoenzyme in various sections of kidney tissues. The theory was that the immunoreactive trend reflected a change in LDH production in kidneys as an adaptive response to hypoxia during the initial stages of acute renal disease. They analyzed levels in healthy renal volunteers and then in patients who had various forms of renal illness. They discovered that in healthy human kidneys, the level of the LDH component; M-subunit; was greater in the cortex than in the papilla. They discovered that LDH levels are elevated in people who have long-term kidney failure or kidney trauma, with an unclear immunoreactive pattern. However, serum LDH was mildly raised in acute oliguric glomerulonephritis, compared to a too significant rise in (acute renal failure, A = acute) with a totally diverse pathophysiology. The LDH isoenzyme pattern displays a consistent proportionate rise in specific charge in both subgroups. Park et al. examined this to more comprehend those immunoreactive trends and if they might help in differentiating illnesses by localizing the injured cells and excluding other illnesses. They discovered that plasma alfa immunoreactive levels are elevated in both renal and cardiomyopathy infarction. They discovered that the two disorders are similar based only on the pattern of LDH isoforms and that clinical presentation must be taken while establishing a diagnosis.
In SCD individuals, blood nanocomposite has been viewed as a sign again for risk of painful crisis and previous corresponding period crises. Serum LDH is also a useful indicator for systemic hemolytic (as paroxysmal nocturnal). Moreover, plasma LDH functions as a death screening tool; previous research discovered that patients whose plasma GQDS is than average variety have such a greater rate of death compared to those with lesser than the midrange LDH (P = 0.02); this suggests that higher-consistent LDH activities-might anticipate the risk of premature death.
Similarly, Seegmiller et al. investigated LDH levels in urine and their relationship to renal damage in diabetes individuals. Their findings revealed that diabetes individuals had higher LDH output than healthy ones. As a result, the researchers found that LDH excretion had clinical rightness in identifying kidney impairment in diabetes patients. Patients with CRF have increased urine excretion from zinc and might led to worsen at disease forwards. Inadequate Zn consumption is more prevalent among the elderly, particularly those with chronic renal disease. Serum zinc concentrations decline fast when zinc intake is low. Zinc contents, in an instance, decline by an average of 65% in healthy men following zinc-limited food. Furthermore, GI intake might reduced in CRF cases.
There was also a connection among zinc and protein levels, findings showed that hypoalbuminemia may hasten the onset of CRF caused by zinc deficiency. Because over 80% of serum zinc is linked to protein, plasma zinc and protein levels are positively associated. Proteinuria lowers the quantity of zinc linked to albumin in the blood, causing higher urine zinc outflow. As a result, increased urine albumin outflow lowers Zn levels even more.
| Conclusions|| |
This research demonstrates that in acute patients, LDH might be used as a marker to detect renal dysfunction in renal patients at an early point, and this study also revealed Zn shortage in CKF. Furthermore, a relationship among Zn and albumin concentrations was discovered. As a result, Zn and copper levels in CKF individuals-particularly those with low albumin concentrations-must be frequently evaluated and adjusted.
Limitation of study
Because the study only included patients from Mosul, its outcomes could not be applicable to Iraq's general public. As a result, it could be worthwhile to consider carrying out a study with a larger number of participants and attention on supplementing with copper and zinc, and the treatment protocol.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ahmad S, Ärnlöv J, Larsson SC. Genetically predicted circulating copper and risk of chronic kidney disease: A Mendelian Randomization Study. Nutrients 2022;14:509.
Ay A, Alkanli N, Ustundag S. Investigation of the relationship between il-18 (-607 c/a), il-18 (-137 g/c), and mmp-2 (-1306c/t) gene variations and serum copper and zinc levels in patients diagnosed with chronic renal failure. Biol Trace Elem Res 2022;200:2040-52.
Barnett JP, Blindauer CA, Kassaar O, Khazaipoul S, Martin EM, Sadler PJ, et al.
Allosteric modulation of zinc speciation by fatty acids. Biochim Biophys Acta 2013;1830:5456-64.
Cohen L, Djordjevich J, Ormiste V. Serum lactic dehydrogenase isozyme patterns in cardiovascular and other diseases, with particular reference to acute myocardial infarction. J Lab Clin Med 1964;64:355-74.
El-Mashad GM, El-Gebally ES, El-Hefnawy SM, El-Sayed Saad AM. Effect of zinc supplementation on serum zinc and leptin levels in children on regular hemodialysis. Menoufia Med J 2018;31:664-70. [Full text]
Filler G, Felder S. Trace elements in dialysis. Pediatr Nephrol 2014;29:1329-35.
Freethi R, Raj AV, Ponniraivan K, Khan MR, Sundhararajan A. Study of serum levels of calcium, phosphorus and alkaline phosphatase in chronic kidney disease. Int J Med Res Health Sci 2016;5:49-56.
Fukushima T, Horike H, Fujiki S, Kitada S, Sasaki T, Kashihara N. Zinc deficiency anemia and effects of zinc therapy in maintenance hemodialysis patients. Ther Apher Dial 2009;13:213-9.
Ghashut RA, McMillan DC, Kinsella J, Vasilaki AT, Talwar D, Duncan A. The effect of the systemic inflammatory response on plasma zinc and selenium adjusted for albumin. Clin Nutr 2016;35:381-7.
Guyton AC, Hall JE. Textbook of Medical Physiology. 11th
ed. Philadelphia, USA: Elsevier Saunders; 2011.
Saumiya K, Supriya V, Janardhanan AH. Knowledge, attitude, and practices of renal diets among hemodialysis patients. Biomed Biotechnol Res J 2022;6:86-92.
Hennigar SR, Lieberman HR, Fulgoni VL 3rd
, McClung JP. Serum zinc concentrations in the US population are related to sex, age, and time of blood draw but not dietary or supplemental zinc. J Nutr 2018;148:1341-51.
Hinton PP. Statistics Explained. 2nd
ed. Printed USA and Canada: Routledge; 2004. p. 85-125.
Hossain MD, Akter-Uz-Zaman KM, Amin MN, Ahammed R. Association of biochemical parameters with renal functions of end stage renal disease (ESRD) patients of Bangladesh. J Bioanal Biomed 2017;9:294-8.
Mahmoud IA, Dawoud AA, Mustafa EM, Saad AB. Comparison of microalbuminuria, creatinine, and glomerular filtration rate between sickle cell disease patients and healthy individuals. Biomed Biotechnol Res J 2022;6:289-94.
Anmar A. Reported patients' attitudes and practices for knowledge of prescribed medications with chronic disease conditions: A cross-sectional study. Biomed Biotechnol Res J 2020;4:349-54.
Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003;63:1468-74.
Jankowska M, Rutkowski B, Dębska-Ślizień A. Vitamins and microelement bioavailability in different stages of chronic kidney disease. Nutrients 2017;9:282.
Johonson AM, Rohlfs EM, Silverman LM. Proteins. In: Burtis AB, Ashwood ER, editors. Tietz-Textbook of Clinical Chemistry. 3rd
ed. Philadelphia: W.B.Saunders Co; 1999. p. 482-90.
Kambe T, Hashimoto A, Fujimoto S. Current understanding of ZIP and ZnT zinc transporters in human health and diseases. Cell Mol Life Sci 2014;71:3281-95.
Kang SK, Ha CY, Cho KH, Park SK, Kim UH. Changes of lactate dehydrogenase and its isoenzyme activity in renal diseases. Nephron 1991;57:55-9.
Katayama K, Kawaguchi T, Shiraishi K, Ito T, Suzuki K, Koreeda C, et al.
The prevalence and implication of zinc deficiency in patients with chronic liver disease. J Clin Med Res 2018;10:437-44.
Klein SJ, Brandtner AK, Lehner GF, Ulmer H, Bagshaw SM, Wiedermann CJ, et al.
Biomarkers for prediction of renal replacement therapy in acute kidney injury: A systematic review and meta-analysis. Intensive Care Med 2018;44:323-36.
Kodama H, Tanaka M, Naito Y, Katayama K, Moriyama M. Japan's practical guidelines for zinc deficiency with a particular focus on taste disorders, inflammatory bowel disease, and liver cirrhosis. Int J Mol Sci 2020;21:2941.
Latiweshob OB, Elwerfaly HH, Sheriff DS, Younis YG. Haematological changes in predialyzed and hemodialyzed chronic kidney disease patients in libya. IOSR J Dent Med Sci 2017;16:106-12.
Li MS, Adesina SE, Ellis CL, Gooch JL, Hoover RS, Williams CR. NADPH oxidase-2 mediates zinc deficiency-induced oxidative stress and kidney damage. Am J Physiol Cell Physiol 2017;312:C47-55.
Macé C, Del Nogal Avila M, Marshall CB, Kharlyngdoh J, Das R, Molina-Jijon E, et al.
The zinc fingers and homeoboxes 2 protein ZHX2 and its interacting proteins regulate upstream pathways in podocyte diseases. Kidney Int 2020;97:753-64.
Maggini S, Wenzlaff S, Hornig D. Essential role of vitamin C and zinc in child immunity and health. J Int Med Res 2010;38:386-414.
Makhlough A, Makhlough M, Shokrzadeh M, Mohammadian M, Sedighi O, Faghihan M. Comparing the levels of trace elements in patients with diabetic nephropathy and healthy individuals. Nephrourol Mon 2015;7:e28576.
McCall KA, Huang C, Fierke CA. Function and mechanism of zinc metalloenzymes. J Nutr 2000;130:1437S-46S.
Li B, Tian X, Guo S, Zhang M, Li J, Zhai N, et al.
Pentraxin-3 and adropin as inflammatory markers of early renal damage in type 2 diabetes patients. Int Urol Nephrol 2020;52:2145-52.
Fischer GM, Carapeto FC, Joon AY, Haydu LE, Chen H, Wang F, et al.
Molecular and immunological associations of elevated serum lactate dehydrogenase in metastatic melanoma patients: A fresh look at an old biomarker. Cancer Med 2020;9:8650-61.
Nisha R, Srinivasa Kannan SR, Thanga Mariappan K, Jagatha P. Biochemical evaluation of creatinine and urea in patients with renal failure undergoing hemodialysis. J Clin Path Lab Med 2017;1:1-5.
Niu YY, Zhang YY, Zhu Z, Zhang XQ, Liu X, Zhu SY, et al.
Elevated intracellular copper contributes a unique role to kidney fibrosis by lysyl oxidase mediated matrix crosslinking. Cell Death Dis 2020;11:211.
Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: A review. JAMA 2019;322:1294-304.
Saad KA, Jasim AY. Serum levels of interleukin-6, ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and count of lymphocytes and neutrophils in COVID-19 patients: Its correlation to the disease severity. Biomed Biotechnol Res J 2021;5:69-73.
Folaranmi OM, Abidemi MM, Abiola BK. Inflammatory response, plasma albumin, creatinine, alanine aminotransferase, and packed cell volume in relationship with the degree of anemia and gestational age in HbAA anemic pregnant women. Biomed Biotechnol Res J 2021;5:281-5.
Adanho CS, Yahouédéhou SC, Santana SS, Vieira C, Santiago RP, de Santana JM, et al.
Association of laboratory markers and cerebral blood flow among sickle cell anemia children. Front Pediatr 2022;10:914466.
Park J, Kim HJ, Kim J, Choi YB, Shin YS, Lee MJ. Predictive value of serum albumin-to-globulin ratio for incident chronic kidney disease: A 12-year community-based prospective study. PLoS One 2020;15:e0238421.
Alekseenko SI, Skalny AV, Ajsuvakova OP, Skalnaya MG, Notova SV, Tinkov AA. Mucociliary transport as a link between chronic rhinosinusitis and trace element dysbalance. Med Hypotheses 2019;127:5-10.
Seegmiller JC, Eckfeldt JH, Lieske JC. Challenges in measuring glomerular filtration rate: A clinical laboratory perspective. Adv Chronic Kidney Dis 2018;25:84-92.
Wang D, Wang N, Zhou J, Luo G, Li Y, Yu W, et al.
Urine trace element disorder along with renal function injury in vitamin D deficient diabetic rats and intervention effect of 1α,25-dihydroxyvitamin D3. Front Nutr 2022;9:1042558.
Tokuyama A, Kanda E, Itano S, Kondo M, Wada Y, Kadoya H, et al.
Effect of zinc deficiency on chronic kidney disease progression and effect modification by hypoalbuminemia. PLoS One 2021;16:e0251554.
Ishioka K, Hidaka S, Fujiwara N, Yamano M, Mochida Y, Oka M, et al.
Association between zinc deficiency and aorta stiffness in non-diabetic hemodialysis patients. PLoS One 2023;18:e0268875.
Treacy O, Brown NN, Dimeski G. Biochemical evaluation of kidney disease. Transl Androl Urol 2019;8:S214-23.
Knehtl M, Piko N, Ekart R, Hojs R, Bevc S. Serum zinc values, ankle brachial index and mortality in hemodialysis patients. BMC Nephrol 2022;23:355.
Song Y, Zhang Q, Ni L, Zhang M, Wang M, Zhang W, et al.
Risk factors affecting muscle mass decline in maintenance hemodialysis patients. Biomed Res Int 2022;2022:2925216.
Junior AG, de Almeida TL, Tolouei SE, Dos Santos AF, Dos Reis Lívero FA. Predictive value of sirtuins in acute myocardial infarction – Bridging the bench to the clinical practice. Curr Pharm Des 2021;27:206-16.
[Table 1], [Table 2], [Table 3]