Selenium and All-cause Mortality in End-Stage Renal Disease. Retrospective Observational Cohort Study.

OBJECTIVE: The objectives of the study were to determine whether low plasma selenium levels (<63 µg/L according to population-based reference interval) were associated with poorer survival among adult patients with end-stage renal disease (ESRD) on dialysis treatment and to study whether plasma selenium behaved as a biomarker of mortality risk independent of other monitored biochemical markers. METHODS: This is a retrospective observational cohort study that included 85 patients with ESRD on 3 modalities of dialysis, with a plasma selenium test performed 5-6 years before the study. RESULTS: Patients with low selenium showed an increased risk of all-cause mortality (hazard ratio = 2.952, 95% CI 1.402-6.217) compared with patients with normal or high selenium (>118 µg/L), according to a Cox multivariate model that included age and history of cardiovascular disease as covariates. Patients with low selenium had an increased risk of all-cause mortality (hazard ratio = 2.894, 95% CI 1.457-5.751) according to a model that included age, anemia, and low albumin as covariates. Low albumin patients had an increased risk of having low plasma selenium (odds ratio = 5.778, 95% CI 2.212-15.098). CONCLUSIONS: Low plasma selenium group's survival was significantly lower than that of the group with normoselenemia or hyperselenemia. Plasma selenium behaved as a biomarker of mortality risk independent of other biochemical markers usually monitored in patients with ESRD.

Medición del contenido de selenio en especímenes biológicos: aplicación en el laboratorio clínico / Measurement of selenium content in biological specimens: medicine laboratory application

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El selenio y la desnutrición e inflamación. Estudio preliminar en enfermedad renal crónica avanzada / Selenium, malnutrition and inflammation. A preliminary study in end-stage chronic kidney disease

Introducción: El desgaste proteico-energético y la inflamación crónica en el enfermo renal se relacionan con un aumento de la mortalidad, así como con la aparición de anemia refractaria y alteraciones en el metabolismo óseo-mineral. Entre las causas está el aumento del estrés oxidativo, en el que el selenio desempeña un papel a través de la actividad de varias selenoproteínas. Se investiga la relación entre el selenio plasmático y sérico y la desnutrición e inflamación en pacientes adultos en tratamiento sustitutivo renal. Material y métodos: Estudio observacional transversal que incluyó 85 plasmas o sueros de pacientes en diálisis y 118 de sujetos control. Se midieron selenio y marcadores bioquímicos de nutrición, inflamación y otras comorbilidades. Las comparaciones se realizaron mediante U de Mann-Whitney, ANOVA y chi-cuadrado. Las correlaciones se estimaron mediante Rho de Spearman. Resultados: La mediana de selenio fue 58,2μg/L en el grupo de pacientes y 89,3μg/L en el grupo control (p<0,001). El selenio se correlacionó con la albúmina (Rho=0,440), el colesterol (Rho=0,278) y la creatinina (Rho=0,367) en los pacientes. La clasificación en función de la hiposelenemia llevó a 2 grupos con diferencia significativa en el tiempo en diálisis (p=0,018), la albúmina (p=0,003), la creatinina (p=0,004), el colesterol (p=0,038) y el fosfato (p=0,025). Conclusiones: El selenio se correlaciona con los marcadores nutricionales en el grupo de pacientes. La clasificación de los pacientes según hiposelenemia lleva a 2 poblaciones diferenciadas en el estado nutricional y en el tiempo en diálisis. El selenio podría ser un marcador útil en el diagnóstico de desgaste proteico-energético

Introduction: Protein-energy wasting and chronic inflammation in renal patients are related to an increase in mortality, as well as the occurrence of unresponsive anaemia and mineral and bone disease. The increase in oxidative stress, in which selenium plays a role, is among the causes of malnutrition and inflammation. The relationship between plasma or serum selenium and malnutrition and inflammation in adult patients undergoing renal replacement therapy is investigated. Material and methods: Cross-sectional observational study that included 85 plasma specimens from patients on dialysis, and 118 from control subjects. Selenium and biochemical markers of nutrition, inflammation, and co-morbidities were measured. The comparisons were using Mann-Whitney, ANOVA and chi-squared tests. Correlations were estimated using Spearman's Rho. Results: The median selenium was 58.2μg/L in the patient group, and 89.3μg/L in the control group (p<.001). Selenium correlated with albumin (Rho=0.440), cholesterol (Rho=0.278) and creatinine (Rho=0.367) in the patient group. Patients classification based on selenium level led to significant differences between the 2 groups in time on dialysis (p<.018), albumin (p<.003), creatinine (p<.004), cholesterol (p<.038) and phosphate (p<.025). Conclusions: Selenium positively correlates with nutritional markers in the group of patient group. According to selenium level, there are 2 populations differentiated by nutritional status and time on dialysis. Plasma selenium is a potentially useful marker for protein-energy wasting diagnosis