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Short Communication
�87 S. Karger A G. Basel
0028 2766/87 (1452 - 0 15 1$2.75/0
Nephron 45 : 151-153 (1987)
Serum and Corpuscular Nickel and Zinc in Chronic Hemodialysis Patients
Shinichi Hosokawa a. Hiroshi Nishilania. Kisaburo Umemurah, Tadao Tomoyoshib, Kenji Sawanishie,
Osamu Yoshidac
?'Utano
National Hospital, bShiga University of Medical Science,? Hemodialysis Center. Kyoto University, Kyoto, Japan
Key Words. Serum nickel ? Serum zinc ? Corpuscular nickel ? Corpuscular zinc ? Hemodialysis ? Chronic renal
failure patients
Abstract. Serum and corpuscular nickel and zinc concentrations in 30 chronic hemodialysis patients were
examined. Serum nickel and zinc levels before dialysis were 0.22�03 pg/dl (normal value: 0.56�08 pg/dl) and
70.0�.4 pg/dl (normal value: 96�jxg/dl) low, respectively. However, corpuscular nickel and zinc levels before
dialysis were high: 1.25 �24 pg/dl (normal value: 0.88 �17 pg/dl) and 1,299� 146 pg/dl (normal value: 1,120�
pg/dl). Serum zinc levels significantly increased after dialysis, but serum nickel concentrations did not significantly
increase during dialysis. Corpuscular nickel and zinc concentrations did not significantly change during dialysis.
Serum nickel and zinc are known to be generally
deficient in patients undergoing chronic hemodialysis.
Nickel deficiency can cause retarded growth and reduc�
tion of blood hemoglobin concentrations, hematocrit
values and erythrocyte counts. [1, 2]. Serum zinc defi�
ciency in chronic hemodialysis patients has been known
to cause anorexia, slow wound-healing and testicular
atrophy [2, 3].
Because nickel and zinc have similar biological pro�
perties, we examined serum and corpuscular nickel and
zinc concentrations in chronic hemodialysis patients.
Materials and Methods
We studied 30 chronic renal patients undergoing 5-hour dialysis
3 times a week using various kinds of hollow-fiber dialyzers. Cuprophan. cellulose acetate and regenerated cellulose acetate with sur�
face areas varying between 0.9 and 1.6 m:.
All subjects were outpatients (13 male, 17 female: average age 42.
with an average duration of dialysis of 50 � 16 months). We mea�
sured the serum and corpuscular nickel and zinc concentrations
before and after dialysis. We also measured serum and corpuscular
nickel and zinc concentrations in 30 healthy normal subject. When
collecting blood, we used various kinds of plastic cannula and
containers that had been acid-leached and screened to ensure that
they were nickel- and zinc-free. Blood samples were obtained from
our patients in the morning before dialysis; the patients had no
breakfast on the examination days. During the examination period,
our patients ate lunch after dialysis in order to prevent a rise in
serum nickel and zinc levels due to calorie intake.
Serum and corpuscular nickel were determined by the standard
dilution method. These measurements were made using an atomic
absorption spectrophotometer (Japan Electron K.K.) equipped
with a nickel hollow-cathode using a 232-nm wavelength, 16-mA
lamp current, 0.1-mm slit width and an air-acetylene system (airflow
23 liters/min, 0,4 kg/cm :) designed to gradually increase the tem�
perature. Serum and corpuscular zinc were measured using a flame�
less atomic absorption spectrophotometer (Japan Electron K.K.)
equipped with a zinc hollow-cathode using a 213.8-nm wavelength,
10-mA lamp current, 0.1-nm slit width, and an air-acetylene system
(airflow 10 liters/min, 1.5 k g /c n f; acetylene flow 2.5 liters/min, 0.4
kg/cm : ) designed to gradually increase the temperature. We used
Student's t test, regarding a 95% level of confidence (p<0.05) as
significant.
Results
In 30 normal subjects, serum and corpuscular nickel
levels were 0.56�8 and 0.88�17 pg/dl; serum and
corpuscular zinc levels were 96 � 8 and 1,120 � 80 ug/dl,
respectively.
In the 30 chronic hemodialysis patients, serum nickel
levels before dialysis and after dialysis were 0.22 �03
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Introduction
152
Hosokawa/Nishitani/Umemura/Tomoyoshi/Sawanishi/Yoshida
Table I. Measurements of serum and corpuscular nickel and zinc levels of 30 chronic uremic patients before and after hemodialysis
treatment (jig/dl)
Case
s-Ni(b)
s-Ni(a)
c-Ni(b)
c-Ni(a)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
0.20
0.23
0.15
0.19
0.29
0.21
0.21
0.24
0.20
0.22
0.22
0.13
0.23
0.21
0.19
0.21
0.23
0.19
0.23
0.20
0.23
0.26
0.18
0.22
0.22
0.26
0.18
0.20
0.23
0.29
0.18
0.25
0.12
0.23
0.30
0.34
0.22
0.29
0.29
0.24
0.24
0.19
0.28
0.30
0.21
0.17
0.26
0.24
0.26
0.32
0.17
0.23
0.20
0.24
0.28
0.21
0.27
0.25
0.26
0.30
1.12
1.18
1.30
1.29
1.24
1.34
1.43
1.20
1.28
1.22
1.09
1.12
1.35
1.23
1.51
1.24
1.55
1.08
Ml
1.34
1.27
1.21
0.80
1.37
2.15
1.26
0.99
0.67
1.32
0.24
1.04
1.27
1.21
1.28
1.21
1.30
1.35
1.28
1.25
1.16
1.03
1.24
1.37
1.33
1.66
1.15
1.43
0.90
1.40
1.42
1.18
1.20
0.66
1.21
1.36
1.22
1.36
0.84
1.26
0.21
Mean 盨 D
0.22 �03
0.25 �05
1.25 �24
1.22 �19
serum nickel levels before dialysis
serum nickel levelsafterdialysis
corpuscular nickel levels before dialysis
corpuscular nickel levelsafterdialysis
and 0.25 + 0.05 ug/dl; the difference was not significant.
Corpuscular nickel levels before and after dialysis were
1.25� 0.24 and 1.22�19 ,u g/dl.
In the hemodialysis patients, serum zinc levels before
and after dialysis were 59.5 � 13.0 and 70.0� 13.4 ug/dl,
with a significant difference. Corpuscular zinc levels
before and after dialysis were 1299 � 146 and 1,302 � 144
ug/dl (non significant difference). These results are
shown in table 1.
62.4
59.5
56.4
54.0
81.3
51.5
44.9
56.4
67.3
72.7
70.7
53.4
?47.4
69.9
40.0
44.8
51.9
70.7
35.5
78.0
73.6
47.7
50.4
50.8
44.4
74.2
48.7
76.2
70.2
81.3
59.5 �.0
s-Zn(b)
s-Zn(a)
c-Zn(b)
c-Zn(a)
s-Zn(a)
c-Zn(b)
c-Zn(a)
79.5
78.2
72.7
67.3
98.7
63.1
60.0
62.4
80.0
80.5
80.4
56.2
53.4
61.2
49.8
60.8
56.2
77.4
47.2
82.9
87.2
52.6
60.8
64.8
62.1
83.9
68.7
79.6
74.6
98.7
1.301
1,115
1,214
1.724
1,518
1,288
1,265
1.352
1,276
1,293
1,253
1,306
1.348
1,290
1,620
1,180
1.106
1,401
1,153
1,237
1,216
1.340
1,106
1,124
1,237
1,312
1.124
1,343
1,396
1,520
1,273
1.084
1.171
1.413
1,452
1,253
1.264
1.485
1,277
1,329
1,176
1,346
1.385
1,203
1.676
1,002
1.264
1,434
1,163
1,384
1,161
1.464
998
1,338
1.322
1,369
1,240
1,348
1,317
1,458
70.0 � 13.4
1,299 � 146
1,302 � 144
serum zinc levels before dialysis
seru m zinc levels after dialysis
corpuscular zinc levels before dialysis
corpuscular zinc levels after dialysis
Discussion
Both nickel and zinc have been found to be deficient in
the serum of chronic hemodialysis patients [2,3]. In the 30
patients enrolled in this study, serum nickel levels before
dialysis were 0.22�03 ug/dl, significantly lower than
in the 30 normal subjects (0.56 � 0.08 ug/dl). Me Neely et
al. [4] also reported that serum nickel concentrations in
uremic patients were lower than in normal subjects. Se�
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s-Ni(b)
s-Ni(a)
c-Ni(b)
c-Ni(a)
s-Zn(b)
Serum and Corpuscular Nickel and Zinc in Chronic Hemodialysis Patients
significantly higher than serum nickel and zinc levels in
normal healthy subjects and chronic hemodialysis pa�
tients. Corpuscular nickel, corpuscular zinc and serum
nickel levels did not change significantly during dialysis.
However, serum zinc levels increased significantly after
dialysis.
References
1 Schnegg, A.; Kirchgessner, M.: Essentiality of nickel for the
growth of animals. Z. Tierphysiol. Tierern鋒r. Futtermittel. 36 :
63-74(1975).
2 Condon, C.J.: Freeman, R.M.: Zinc metabolism in renal failure.
Ann. intern. Med. 73: 531-536 (1970).
3 Hosokawa, S.: Kohira, S.: Imai, T.: Tomoyoshi. T.: Nishio, T.:
Sawanishi, K.: Zinc transfer during hemodialysis in chronic
renal failure patients. Blood Purification 1: 225-230 (1983).
4 McNeely, M.D.;Sunderman, F.W.; Nechay,M.W.; Levene, H.:
Abnormal concentrations of nickel in serum in cases of myo�
cardial infarction, stroke, burns, hepatic cirrhosis and uremia.
Clin. chem. 77:1123-1128 (1971).
5 Nomoto, S.: Sunderman, F.W.: Atomic absorption spectrome�
try of nickel in serum urine, and other biological materials. Clin,
chem. 16: 477-485 (1970).
6 Gidden, H.: Holland, F.F.; Klein, K.: Trace metal protein bind�
ing in normal and dialyzed uremic serum. Trans. Am. Soc. artif.
internal, organs. 26:133-138(1980).
7 Hosokawa, S.; Nishitani, H.; Umemura, K.; Nishio, T.: Tomoy�
oshi. T.: Sawanishi, K.; Yoshida. O.: Nickel transfer during
hemodialysis. Trans. Am. Soc. artif. internal organs. 31: 38-41
(1985).
8 Sunderman, F.W.: A review of the metabolism and toxicology of
nickel. Ann. clin. Lab. Sei. 7:377-397 (1977).
Accepted: July 1,1986
Shinichi Hosokawa, MD,
Hemodialysis Center,
Utano National Hospital,
8 Ondoyama-cho,
Narutaki, Ukyo-ku,
Kyoto-City 616 (Japan)
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rum nickel concentrations did not significantly increase
after dialysis (0.22 �03 vs 0.25 �05 (xg/dl; (table I).
Corpuscular nickel levels before dialysis in our patients
were 1.25 � 0.24 pg/dl, significantly higher than in nor�
mal healthy subjects (normal average: 0.88 �17 (ig/dl).
The preceding results agree with those obtained by Nomoto and Sunderman [5].
There was no significant difference between corpus�
cular nickel levels before (1.25 �24 ug/dl) and after
dialysis (1.22 �19 jxg/dl). Nor were the serum nickel
levels after dialysis increased compared to predialysis
levels.
Gidden et al. [6] and Hosokawa et al. [7] previously
reported that serum nickel did not move to the dialysate
nor did it transfer from the dialysate to the blood, because
no difference was found between dialysate nickel levels
(0.10-0.02 ug/dl) and free diffusible serum nickel levels
(0.10-0.12 ug/dl) in chronic dialysis patients. Nickel was
not liberated from the dialyzer membrane after washing
the dialyzer with 1.000 ml normal saline. Therefore, the
change of serum nickel levels in chronic hemodialysis
patients was apparently caused by hemoconcentration.
This results suggests that the change of corpuscular and
serum nickel levels during dialysis was influenced by
hemoconcentration, because corpuscular nickel did not
move through the dialyzer membrane.
Serum zinc levels before dialysis significantly in�
creased (59.5 � 13.0 to 70 � 13.4 pg/dl) after dialysis (table
I). This change occurred mainly by hemoconcentration
and partially by diffusion as we previously reported [3].
The percent of ultrafiltrable zinc fraction was about 10%
in total serum zinc of uremic patients [6], We did not find
any significant difference between corpuscular zinc lev�
els before dialysis (1,299 �6 pg/dl) and after dialysis
1,302� 144 ug/dl; (table I). These results show that cor�
puscular zinc levels hardly changed at all during hemodi�
alysis.
In conclusion, serum nickel and zinc concentrations
before dialysis were low in chronic renal failure patients.
Other researchers have suggested previously that nickel
and zinc play an important role in controlling anemia and
in nutrition of chronic hemodialysis patients [2,8]. Cor�
puscular nickel and zinc levels in chronic dialysis dialysis
patients were high. Corpuscular nickel and zinc levels are
153
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