Association of Serum Nickel Concentrations with Clinical Characteristics in Patients with ESKD Undergoing Hemodialysis

Background: Limited studies have investigated serum nickel concentrations in patients with end-stage renal disease (ESRD) undergoing hemodialysis, and the association of serum nickel concentration with dialysis-related profiles is unknown. Methods: The investigators conducted a prospective cohort study at a tertiary medical center in Taiwan. 409 patients with ESRD undergoing permanent hemodialysis were enrolled. Serum nickel concentrations, hematological and biochemical laboratory data, dialysis-related data, and patient demographics were obtained at baseline. The patients were stratified into 4 quartiles according to serum nickel concentrations. All-cause mortality was recorded after an 18-month follow-up period. Results: Ninety-eight percent of the patients had elevated serum nickel concentrations compared to the reference value (2 μg/L). There was a significant trend among the four groups, where a greater quartile of serum nickel concentration had higher levels of hemoglobin, albumin, high-density lipoprotein (HDL), and lower levels of white blood cell (WBC), uric acid, triglyceride, and log high-sensitivity C-reactive protein (hs-CRP). Furthermore, a greater quartile of serum nickel had a longer dialysis vintage, higher Kt/V, and higher urea removal rate (URR). Multivariate analysis revealed that albumin level and dialysis vintage were independent factors associated with serum nickel concentration. A positive correlation was observed between albumin level and dialysis vintage with serum nickel concentration (R = 0.163, P = 0.001; R = 0.212, P < 0.001, respectively). There was no statistically significant difference in the all-cause mortality rate across the quartiles. Conclusion: The majority of ESRD patients undergoing hemodialysis had elevated serum nickel concentrations above the reference level. Longer dialysis vintage and higher albumin level were associated with higher serum nickel concentrations. No association was observed between serum nickel concentration and the all-cause mortality rate.(A) Correlation between serum nickel and albumin. (B) Correlation between serum nickel and dialysis vintage.