Lower levels of selenium are independently associated with increased risks of death and hospitalization among patients on hemodialysis, according to a new study published online ahead of print in the Clinical Journal of the American Society of Nephrology.

In a prospective longitudinal study examining blood concentrations of 25 trace elements and associated outcomes in 1278 HD patients, Marcello Tonelli, MD, of the University of Calgary in Calgary, Alberta, and colleagues found that patients in the lowest decile of selenium concentration had a significant 3.4-fold increased odds of death and 3.6-fold increased odds of all-cause hospitalization in adjusted analyses compared with patients in deciles 2–9. Each decile increase in selenium concentration was associated with a 14% decreased risk of death and 8% decreased risk of hospitalization.

Results also showed that the highest decile of cadmium levels was associated with a significant 1.9-fold increased odds of death compared with the remaining deciles, and each decile increment in copper concentration was associated with a significant 7% increased odds of death. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with a higher risk of clinical outcomes.

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The investigators noted that selenium has multiple biologic functions, and lower selenium levels have been associated with various adverse clinical and biochemical outcomes, including cardiovascular disease, diabetes, and malnutrition.

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“Future studies should evaluate the potential benefits of improving selenium concentrations among patients on hemodialysis,” the authors concluded.


Tonelli M, Wiebe N, Bello A, et al. Concentrations of trace elements and clinical outcomes in hemodialysis patients. Clin J Am Soc Nephrol. 2018; published online ahead of print.