2025 Volume 14 Issue 2 Pages 207-213
【Background】Dialysis patients are prone to zinc deficiency. However, excessive zinc supplementation can lead to copper deficiency, which may cause cytopenia, including anemia. In this study, we evaluated the appropriate zinc dosage in dialysis patients from the perspective of the risk of copper deficiency.
【Method】Ten hemodialysis patients who newly started zinc supplementation with zinc acetate hydrate (Nobelzin® tablets) and had measurable serum zinc and copper concentrations were included. Changes in serum zinc and copper levels were monitored for up to one year after the start of treatment. Data are presented as medians [minimum – maximum].
【Results】Five patients each received a daily dose of 25 mg or 50 mg of zinc acetate hydrate. Serum zinc concentrations increased from 58 [45 – 84] µg/dL before treatment to 114 [46 – 155] µg/dL after treatment, while serum copper concentrations changed from 83 [58 – 121] µg/dL to 91 [8 – 113] µg/dL (N=10).
When analyzed by dosage group, the serum zinc levels were 106.5 [87.0 – 126.0] µg/dL in the 25 mg/day group and 114.0 [46.0 – 155.0] µg/dL in the 50 mg/day group. Within one year of starting zinc acetate hydrate, treatment was discontinued in one patient from the 25 mg/day group and in all five patients from the 50 mg/day group.
After initiating zinc acetate hydrate, the serum copper concentrations were 103.0 [91.0 – 113.0] µg/dL in the 25 mg/day group and 12.0 [8.0 – 92.0] µg/dL in the 50 mg/day group. Treatment was discontinued in four patients from the 50 mg/day group due to decreased serum copper levels, whereas no such cases were observed in the 25 mg/day group. In the 50 mg/day group, copper deficiency was observed as early as three months after starting supplementation. In one patient from the 50 mg/day group, treatment was discontinued at nine months due to suspected copper deficiency-related cytopenia, which subsequently improved.
【Conclusion】From the perspective of copper deficiency risk, when initiating zinc acetate hydrate at doses of 50 mg/day or more in dialysis patients, monitoring of the serum copper levels within at least three months is necessary. The results indicated that zinc supplementation was effective even at 25 mg/day, suggesting that initiating treatment at a lower dose is reasonable.
