Work

Long-term effects of zinc replacement therapy continuation in hemodialysis patients on mortality and nutritional indices: A posthoc analysis

Year: 2026

Type: article

Abstract: Background Zinc deficiency has been identified as an important factor contributing to chronic nutritional disorders in maintenance hemodialysis (HD) patients. Aim We assessed the long-term effect of zinc replacement therapy on all-cause mortality among patients undergoing HD. Methods This posthoc analysis utilized data from an open-label, multicenter, randomized, active-controlled study including HD patients aged 40–94 years, registered between December 2019 and May 2020. Patients who initiated zinc supplementation were categorized into two groups based on treatment status 12 months after initiation: continuation (n = 46) and discontinuation (n = 22). The primary outcome was 4-year all-cause mortality. Survival was compared by Kaplan–Meier analysis, and hazard ratios (HRs) were estimated using Cox proportional hazards models. Summary The 4-year survival rate was higher in the continuation group (54.8%) than in the discontinuation group (33.9%, log-rank P = 0.122). Continuation of zinc therapy significantly reduced mortality risk (HR: 0.33, 95% CI: 0.11–0.95, P = 0.041). Independent predictors of mortality included age (HR: 1.09 per year), female sex (HR: 2.46), primary kidney disease (HR: 2.81), serum albumin <3.5 g/dL (HR: 4.35), transthyretin <20 mg/dL (HR: 3.59), and phosphorus <3.7 mg/dL (HR: 3.28). Subgroup analysis revealed that albumin ≥3.5 g/dL was protective in the continuation group, while malnutrition and inflammation markers were strongly associated with mortality in the discontinuation group. Continuation of zinc replacement therapy was associated with significantly improved survival in HD patients. These findings suggest that sustained supplementation may provide prognostic benefit, particularly in those with preserved nutritional status. Registration The study was registered with the University Hospital Medical Information Network (UMIN) under registration number 000038759.

Source: Nutrition and Health

DOI: 10.1177/02601060261445340