Serum Zinc Levels of Patients with COVID-19 Undergoing Hemodialysis

Purpose: Strategies to minimize Coronavirus Disease (COVID-19) transmission in patients undergoing hemodialysis have been implemented worldwide. Chronic kidney disease is a risk factor for COVID-19 and zinc could exert antiviral effects by suppressing viral replication and enhancing immune responses. Therefore, this study investigated the serum zinc levels of patients with COVID-19 undergoing hemodialysis. Method: This multicenter retrospective observational study included outpatients undergoing hemodialysis. We measured the serum zinc levels of patients with and without COVID-19 undergoing hemodialysis and compared the levels with those of adults with normal renal function. Results: Of 91 patients undergoing hemodialysis, 24 (26.4%) tested positive for severe acute respiratory syndrome coronavirus-2 and 67 (73.6%) did not. All 24 patients with COVID-19 had hypozincemia (mean serum zinc level: 58.9±7.5 μg/dL): 9 (37.5%) had mild hypozincemia (zinc: <80 μg/dL) and 15 (62.5%) had severe hypozincemia (zinc: <60 μg/dL). Among patients undergoing hemodialysis, the mean serum zinc level in those with COVID-19 was significantly lower than that in patients without COVID-19 (58.9±7.5 vs. 63.3±11.4 μg/dL; p=0.03436). The mean serum zinc level of patients with COVID-19 undergoing HD was significantly lower than that in adults with normal renal function (58.9±7.5 vs. 78.0±8.3 μg/dL; p=0.00042). Conclusion: Japanese patients with COVID-19 undergoing hemodialysis had low serum zinc levels. Most patients undergoing hemodialysis had hypozincemia. Hypozincemia therefore may be a risk factor for COVID-19 in patients undergoing hemodialysis.