The Relationship Between Serum Zinc Levels and Tumor Markers in Hemodialysis Patients

Abstract

The incidence of neoplasia is increased in end-stage renal disease (ESRD) patients. Zinc (Zn) deficiency is associated with neoplasia and also commonly seen in ESRD patients. However, the data regarding the relationship between Zn levels and tumor markers is scant in this population. We aimed to investigate the relationship between Zn levels and tumor markers in hemodialysis patients. Twenty-six hemodialysis patients (11 male, 15 female, mean age 41.6±14.3 years) and 11 healthy subjects (6 male and 5 female, mean age 38.7±7.2 years) were included. Serum Alpha fetoprotein (AFP), carcinoembriyonic antigen (CEA), CA 19-9, CA 15-5, CA 125, beta subunit of human corionic gonadotrophin (β-HCG) and beta-2 microglobulin (β2M) and Zn levels were measured. Data were analysed by Student’s t test. Serum Zinc levels were significantly lower in ESRD patients (group 1) compared to healthy subjects (group 2) (p<0.0001, for all). Serum CEA and β2M levels were also significantly higher in group 1 patients compared to group 2 subjects (p<0.005, p<0.0001, respectively). Serum Ca15-3 and CA-125 levels were found to be significantly lower in group 1 patients compared to group 2 subjects (p<0.005, p<0.001, respectively). There were no statistically significant difference in terms of serum CA 19-9, β-HCG and AFP between group 1 and group 2 patients. In group 1 patients, there was a negative correlation between serum Zn levels and AFP, while a positive correlation was obsorved between serum Zn levels and CA15-3. The measurement of AFP may be beneficial in HD patients. Further studies are needed

Keywords

• Hemodialysis, zinc, tumor markers

The Relationship Between Serum Zinc Levels and Tumor Markers in Hemodialysis Patients

Öz

Son dönem böbrek yetersizliği (SDBY) bulunan hastalarda neoplazi insidansı artmıştır. Çinko (Zn) eksikliği neoplazi gelişimi ile ilişkilidir ve bu durum SDBY hastalarında sıklıkla görülmektedir. Bununla birlikte bu populasyonda serum Zn düzeyleri ile tumor belirteçleri arasındaki ilişki bilinmemektedir. Çalışmamızda hemodiyaliz hastalarında serum Zn düzeyleri ile tümör belirteçleri arasındaki ilişkiyi araştırmayı hedefledik. Çalışmaya 26 hemodiyaliz hastası (11 erkek, 15 kadın, yaş ortalaması 41.6±14.3 yıl) ve 11 sağlıklı birey (6 erkek, 5 kadın, yaş ortalaması 38.7±7.2) dahil edildi. Serum alfa fetoprotein (AFP), karsinoembriyonik antijen (CEA), CA 19-9, CA 15-5, CA 125, beta HCG, beta-2 mikroglobulin (β2M) ve Zn değerleri ölçüldü. Veriler Student t test ile analiz edildi. Serum Zn düzeyleri SDBY hastalarında (grup 1) sağlıklı bireylere (grup 2) oranla anlamlı olarak düşük saptandı (p<0.0001). Serum CEA ve β2M düzeyleri grup 1 hastalarda anlamlı olarak yüksekti (sırasıyla, p<0.005 ve p<0.0001). Serum Ca15-3 and CA125 düzeyleri ise grup 1 hastalarda anlamlı olarak düşük saptandı (sırasıyla, p<0.005 ve p<0.001). Her iki grup arasında serum CA 19-9, β-HCG ve AFP açısından anlamlı fark yoktu. Grup 1 hastalarda serum Zn seviyesi ile AFP arasında pozitif korelasyon ve CA 15-3 arasında negatif korelasyon vardı. Hemodiyaliz hastalarında AFP ölçümü faydalı olabilir. Bu konuyla ilgili detaylı çalışmalara ihtiyaç vardır

Anahtar Kelimeler

• Hemodiyaliz, çinko, tümör belirteçleri

References

1. Shrimpton R, Gross R, Darnton-Hill I, Young M. Zinc defi- ciency: what are the most appropriate interventions? BMJ 2005 12;330(7487):347-9.
2. Zima T, Tesar V, Mestek O, Nemecek K. Trace elements in end-stage renal disease. Blood Purif 1999;17(4):187-98.
3. D'Haese PC, De Broe ME. Adequacy of dialysis: trace ele- ments in dialysis fluids. Nephrol Dial Transplant 1996;11 Suppl 2:92-7.
4. Prasad AS. Zinc deficiency in humans: a neglected prob- lem. J Am Coll Nutr 1998 Dec;17(6):542-3.
5. Rink L, Gabriel P. Zinc and the immune system. Proc Nutr Soc 2000;59(4):541-52.
6. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr 1998;68(2 Suppl):447S-63S.
7. Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of end-stage renal disease in the United States. Am J Kidney Dis 2005;45(1 Suppl 1):A5-7, S1-280.
8. Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, ac- cess and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney Int 2005;68(1):311-8.

9. O'Seaghdha CM, Foley RN. Septicemia, access, cardiovas- cular disease, and death in dialysis patients. Perit Dial Int 2005;25(6):534-40.
10. Lindner A, Farewell VT, Sherrard DJ. High incidence of neoplasia in uremic patients receiving long-term dialysis. Cancer and long-term dialysis. Nephron 1981;27(6):292-6.
11. Lye WC, Tambyah P, Leong SO, Lee EJ. Serum tumor mark- ers in patients on dialysis and kidney transplantation. Adv Perit Dial 1994;10:109-11.
12. Tonelli M, Wiebe N, Hemmelgarn B, et al. Trace elements in hemodialysis patients: a systematic review and meta- analysis. BMC Med 2009;7:25.
13. Castro L, Freeman BA. Reactive oxygen species in human health and disease. Nutrition 2001;17(2):161, 3-5.
14. Abnet CC, Lai B, Qiao YL, et al. Zinc concentration in esophageal biopsy specimens measured by x-ray fluores- cence and esophageal cancer risk. J Natl Cancer Inst 2005 16;97(4):301-6.
15. Tzitzikos G, Saridi M, Filippopoulou T, et al. Measurement of tumor markers in chronic hemodialysis patients. Saudi J Kidney Dis Transpl 2010;21(1):50-3.
16. Sutherland GA, Glass J, Gabriel R. Increased inci- dence of malignancy in chronic renal failure. Nephron 1977;18(3):182-4.
17. Kuno T, Kaizu K. Use of tumor markers in patients on chronic hemodialysis. Nihon Rinsho 2004;62 Suppl 6:391-4.
18. Polenakovic M, Sikole A, Dzikova S, Polenakovic B, Gelev S. Acquired renal cystic disease and tumor mark- ers in chronic hemodialysis patients. Int J Artif Organs 1997;20(2):96-100.
19. Menzin AW, Kobrin S, Pollak E, Goodman DB, Rubin SC. The effect of renal function on serum levels of CA 125. Gynecol Oncol 1995;58(3):375-7.
20. Pecchio F, Rapellino M, Ruffini E, Cavallo A. Half-life of carcinoembryonic antigen following curative resec- tion of adenocarcinoma of the lung. Int J Biol Markers 1992;7(2):119-20.
21. Zeferos N, Digenis GE, Christophoraki M, et al. Tumor markers in patients undergoing hemodialysis or kidney transplantation. Nephron 1991;59(4):618-20.
22. Eskiocak S, Dortok H, Alvur M, Cengiz K. Tumour mark- ers in chronic renal failure and haemodialysis patients. Nephrol Dial Transplant 1995;10(7):1256.
23. Camci C, Buyukberber S, Tarakcioglu M, et al. The effect of continuous ambulatory peritoneal dialysis on serum CA-125 levels. Eur J Gynaecol Oncol 2002;23(5):472-4.
24. Prasad AS, Beck FW, Snell DC, Kucuk O. Zinc in cancer prevention. Nutr Cancer. 2009;61(6):879-87.
25. Prasad AS, Kucuk O. Zinc in cancer prevention. Cancer Metastasis Rev 2002;21(3-4):291-5.
26. Goel A, Dani V, Dhawan DK. Protective effects of zinc on lipid peroxidation, antioxidant enzymes and hepatic his- toarchitecture in chlorpyrifos-induced toxicity. Chem Biol Interact 2005 20;156(2-3):131-40.