title: Diuretics aggravate zinc deficiency in patients with liver cirrhosis by increasing zinc excretion in urine.
abstract: OBJECTIVE
  Liver cirrhosis is often accompanied by zinc deficiency. The exact mechanisms underlying zinc deficiency remain unclear. This study was undertaken to clarify the influence of diuretics on blood zinc levels and zinc excretion in urine in liver cirrhosis.
  
  
  METHODS
  Seventy-nine outpatients with liver cirrhosis were divided into four groups: (i) patients receiving no zinc preparations or diuretics (LC group); (ii) those receiving zinc preparations only (LCZ group); (iii) those receiving diuretics only (LCD group); and (iv) those receiving both zinc preparations and diuretics (LCDZ group). Among these groups, the effects of the administrated drugs on blood zinc levels and urinary zinc excretion were analyzed.
  
  
  RESULTS
  Blood zinc levels were significantly lower in the LCD group (47.8 ± 10.5 μg/dL) than in the other groups (LC: 68.8 ± 17.1 μg/dL, P = 0.0056, post-hoc test; LCZ: 78.4 ± 18.1, P < 0.0001; LCDZ: 70.3 ± 21.4, P = 0.0008). The creatinine-adjusted urinary zinc excretion was significantly higher in the LCDZ group (548.1 ± 407.6 μg/mg creatinine) than in the other groups (LC, 58.5 ± 43.7; LCZ, 208.1 ± 227.8; LCD, 105.2 ± 154.4; each P < 0.0001). The fraction of urinary zinc excretion was also significantly higher in the LCDZ group (5.6 ± 2.9%) than in the other groups (LC, 0.6 ± 0.5; LCD, 1.7 ± 1.5; LCZ, 1.6 ± 1.2; each P < 0.0001).
  
  
  CONCLUSIONS
  In patients with liver cirrhosis, treatment with diuretics can increase zinc excretion by suppressing the reabsorption of zinc through renal tubules, which might lead to zinc deficiency.
authors.affiliation: Department of Internal Medicine, Osaka Koseinenkin Hospital.
authors.forename: Miho
authors.initials: M
authors.lastname: Chiba
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Katayama
authors.forename: Risato
authors.initials: R
authors.lastname: Takeda
authors.forename: Rie
authors.initials: R
authors.lastname: Morita
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Iwahashi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Onishi
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Kita
authors.forename: Akira
authors.initials: A
authors.lastname: Nishio
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Kanno
authors.forename: Tamiko
authors.initials: T
authors.lastname: Saito
authors.forename: Kosaku
authors.initials: K
authors.lastname: Maeda
authors.forename: Masafumi
authors.initials: M
authors.lastname: Naito
authors.forename: Tomoki
authors.initials: T
authors.lastname: Michida
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ito