title: Trace Elements in Chronic Haemodialysis Patients and Healthy Individuals-A Comparative Study.
abstract: BACKGROUND
  End Stage Renal Disease (ESRD) patients despite receiving adequate Haemodialysis (HD) develop significant risk of Cardiovascular Disease (CVD). Abnormality in levels of trace elements may potentiate vascular injury by producing sustained inflammation and endothelial dysfunction. Hence, the present study was undertaken to evaluate the levels of trace elements in patients receiving HD.
  
  
  OBJECTIVE
  To study the blood levels of arsenic, cadmium, mercury, lead, chromium, barium, cobalt, caesium and selenium among ESRD patients undergoing HD and compare it with healthy individuals.
  
  
  METHODS
  It was a cross-sectional, comparative study done in a tertiary care center. About 40 established ESRD patients aged above 18 years, belonging to both sexes, undergoing chronic HD for more than six months were enrolled as Group A (Cases). Patients who had history of smoking and occupational exposure to heavy metals were excluded from the study. About 40 age and sex matched apparently healthy individuals attending health check-up were enrolled as Group B (Controls). Participants of this group had normal e-GFR by Modification of Diet in Renal Disease (MDRD) equation. About 5ml of fasting venous blood sample was obtained from both groups and analyzed for trace elements. Chi-square/Fisher's-exact test was used for comparing ratios. A p-value of <0.05 was considered statistically significant.
  
  
  RESULTS
  In the present study, the mean blood levels of arsenic, cadmium, chromium and cobalt was found to be significantly higher in Group A as compared to Group B with all these parameters attaining a p-value of <0.001. Similarly, the mean blood levels of lead and caesium was high in Group A with a p-value of 0.001 each. The blood levels of mercury and barium did not vary significantly between both the groups with p=0.656 and 0.096 respectively. The blood levels of anti-oxidant selenium was lower in Group A, but did not attain statistical significance (p=0.217).
  
  
  CONCLUSIONS
  The mean blood levels of toxic trace elements were significantly elevated with a simultaneous reduction in essential trace elements in patients receiving HD, which probably may contribute to an increase in CVD.
authors.affiliation: Associate Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Lokesh
authors.initials: L
authors.lastname: Shanmugam
authors.affiliation: Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Siva Ranganathan
authors.initials: SR
authors.lastname: Green
authors.affiliation: Associate Professor, Department of Nephrology, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Hemachandar
authors.initials: H
authors.lastname: Radhakrishnan
authors.affiliation: Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Tony Mathew
authors.initials: TM
authors.lastname: Kadavanu
authors.affiliation: Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute , SBV University, Puducherry, India .
authors.forename: Arunkumar
authors.initials: A
authors.lastname: Ramachandrappa
authors.affiliation: Resident, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Shashank Rakesh
authors.initials: SR
authors.lastname: Tiwari
authors.affiliation: Resident, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Amirtha Lakshmi
authors.initials: AL
authors.lastname: Rajkumar
authors.affiliation: Senior Statistician and Research Consultant, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
authors.forename: Ezhumalai
authors.initials: E
authors.lastname: Govindasamy
keywords: Endothelial dysfunction; Inflammation; Toxic elements