The Efficacy of Zinc Gluconate Supplementation in the Improvement of Malnutrition Indices and Skin Abnormalities in Hemodialysis Patients: A Randomized Clinical Trial

Overview

Journal Int J Prev Med

Date 2025 Jan 1

PMID 39742128

Authors

Mohammad Tavassoli

Shahrzad Shahidi

Gholamreza Askari

Naser Tavakoli

Cain C T Clark

Mohammad Hossein Rouhani

Affiliations

Soon will be listed here.

Abstract

Background: Hemodialysis patients often suffer from several complications such as malnutrition and skin abnormalities. We hypothesized that zinc supplementation may improve these complications. The aim of the present study was to examine the effects of zinc gluconate supplementation on malnutrition and skin abnormalities.

Methods: In this parallel randomized, double-blind, clinical trial, patients in the zinc group received 210 mg zinc gluconate (equivalent to 30 mg elemental zinc) per day. Skin abnormalities (i.e. xerosis and pruritus), body composition, anthropometric variables, handgrip strength, and appetite (including hunger, fullness, desire to eat, and prospective food consumption) were measured at the beginning and end of the study.

Results: Eighty-seven hemodialysis patients were randomly assigned to the zinc ( = 44) or placebo ( = 43) group for 12 weeks, After this period, 75 patients ( = 38 in the zinc group and 37 in the placebo group) remained in the study. In this study, no specific side effects of zinc supplementation were observed and twelve participants were lost to follow-up ( = 6 in each group) because of migration, kidney transplantation, death, dialysis access infection, and personal reasons. Zinc supplementation had beneficial effects on hunger) 95% CI: 9/55 (3/67-15/42)), desire to eat) 95% CI: 7/03 (1/82-12/24)), and prospective food consumption) 95% CI: 3/46 (0/3-14/1)) compared with placebo. Also, zinc improved pruritus) 95% CI: -0/52 (-0/82 to - 0/22)). We observed no changes in body composition, anthropometric variables, handgrip strength, and xerosis in the zinc group compared with the placebo.

Conclusions: This randomized clinical trial showed that zinc supplementation yielded beneficial effects on appetite and pruritus in hemodialysis patients.

References

Yoosefinejad A, Karjalian F, Momennasab M, Jahromi S . Reliability and validity of the Persian version of 5-D itching scale among patients with chronic kidney disease. BMC Nephrol. 2021; 22(1):16. PMC: 7791997. DOI: 10.1186/s12882-020-02220-x. View

Delanaye P, Quinonez K, Buckinx F, Krzesinski J, Bruyere O . Hand grip strength measurement in haemodialysis patients: before or after the session?. Clin Kidney J. 2018; 11(4):555-558. PMC: 6070033. DOI: 10.1093/ckj/sfx139. View

Khademian M, Farhangpajouh N, Shahsanaee A, Bahreynian M, Mirshamsi M, Kelishadi R . Effects of zinc supplementation on subscales of anorexia in children: A randomized controlled trial. Pak J Med Sci. 2015; 30(6):1213-7. PMC: 4320702. DOI: 10.12669/pjms.306.6377. View

Hakim R, Lazarus J . Initiation of dialysis. J Am Soc Nephrol. 1995; 6(5):1319-28. DOI: 10.1681/ASN.V651319. View

Pupim L, Heimburger O, Qureshi A, Ikizler T, Stenvinkel P . Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus. Kidney Int. 2005; 68(5):2368-74. DOI: 10.1111/j.1523-1755.2005.00699.x. View

Bello A, Okpechi I, Osman M, Cho Y, Htay H, Jha V . Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022; 18(6):378-395. PMC: 8862002. DOI: 10.1038/s41581-022-00542-7. View

Suzuki H, Asakawa A, Li J, Tsai M, Amitani H, Ohinata K . Zinc as an appetite stimulator - the possible role of zinc in the progression of diseases such as cachexia and sarcopenia. Recent Pat Food Nutr Agric. 2011; 3(3):226-31. DOI: 10.2174/2212798411103030226. View

Katta R, Kramer M . Skin and Diet: An Update on the Role of Dietary Change as a Treatment Strategy for Skin Disease. Skin Therapy Lett. 2018; 23(1):1-5. View

Roberts H, Denison H, Martin H, Patel H, Syddall H, Cooper C . A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011; 40(4):423-9. DOI: 10.1093/ageing/afr051. View

10.

Nagaraj S . Loss of Appetite in Adult Patients: Effectiveness and Safety of an Appetite Stimulating Medication in an Open-Label, Investigator-Initiated Study in India. J Nutr Metab. 2022; 2022:2661912. PMC: 8759923. DOI: 10.1155/2022/2661912. View

11.

Nishikawa H, Enomoto H, Yoh K, Iwata Y, Sakai Y, Kishino K . Serum Zinc Concentration and Sarcopenia: A Close Linkage in Chronic Liver Diseases. J Clin Med. 2019; 8(3). PMC: 6462961. DOI: 10.3390/jcm8030336. View

12.

Keane D, Gardiner C, Lindley E, Lines S, Woodrow G, Wright M . Changes in Body Composition in the Two Years after Initiation of Haemodialysis: A Retrospective Cohort Study. Nutrients. 2016; 8(11). PMC: 5133089. DOI: 10.3390/nu8110702. View

13.

Markova A, Lester J, Wang J, Robinson-Bostom L . Diagnosis of common dermopathies in dialysis patients: a review and update. Semin Dial. 2012; 25(4):408-18. DOI: 10.1111/j.1525-139X.2012.01109.x. View

14.

Apetrii M, Timofte D, Voroneanu L, Covic A . Nutrition in Chronic Kidney Disease-The Role of Proteins and Specific Diets. Nutrients. 2021; 13(3). PMC: 7999704. DOI: 10.3390/nu13030956. View

15.

Kovesdy C . Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022; 12(1):7-11. PMC: 9073222. DOI: 10.1016/j.kisu.2021.11.003. View

16.

Hasheminejad N, Namdari M, Mahmoodi M, Bahrampour A, Azmandian J . Association of Handgrip Strength With Malnutrition-Inflammation Score as an Assessment of Nutritional Status in Hemodialysis Patients. Iran J Kidney Dis. 2016; 10(1):30-5. View

17.

Wright M, Jones C . Renal Association Clinical Practice Guideline on nutrition in CKD. Nephron Clin Pract. 2011; 118 Suppl 1:c153-64. DOI: 10.1159/000328067. View

18.

Hwang S, Lee D, Min J, Jeon J . Handgrip Strength as a Predictor of All-Cause Mortality in Patients With Chronic Kidney Disease Undergoing Dialysis: A Meta-Analysis of Prospective Cohort Studies. J Ren Nutr. 2019; 29(6):471-479. DOI: 10.1053/j.jrn.2019.01.002. View

19.

Serup J . EEMCO guidance for the assessment of dry skin (xerosis) and ichthyosis: clinical scoring systems. Skin Res Technol. 2016; 1(3):109-14. DOI: 10.1111/j.1600-0846.1995.tb00029.x. View

20.

Daschner M, Tonshoff B, Blum W, Englaro P, Wingen A, Schaefer F . Inappropriate elevation of serum leptin levels in children with chronic renal failure. European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood. J Am Soc Nephrol. 1998; 9(6):1074-9. DOI: 10.1681/ASN.V961074. View