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Copper deficiency anemia due to zinc supplementation in a chronic hemodialysis patient

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Abstract

Zinc deficiency causes dysgeusia and dermatitis as well as anemia. As approximately half of dialysis patients have zinc deficiency, zinc supplementation should be considered in case of erythropoiesis-stimulating agent (ESA)-hyporesponsive anemia. We report a case of a chronic dialysis patient with copper deficiency anemia caused by standard-dose zinc supplementation. The patient was a 70-year-old woman who had received maintenance hemodialysis for 8 years due to diabetic nephropathy. She had been treated with weekly administration of darbepoetin 30 μg for renal anemia, which resulted in Hb 12 to 14 g/dL. She had no dysgeusia. When zinc deficiency (44 μg/dL) had been identified 4 months earlier, 50 mg daily zinc acetate hydrate (Nobelzin®), which is the standard dose, was started. Unexpectedly, her anemia progressed slowly with macrocytosis together with granulocytopenia. Her platelet count did not decrease at that time. Laboratory tests revealed a marked decrease of serum copper (< 4 μg/dL) and ceruloplasmin (< 2 mg/dL), although serum zinc was within the normal limit (125 μg/dL). We discontinued zinc acetate and started copper supplementation including cocoa for 1 month. Her anemia and granulocytopenia were dramatically restored coincident with the increase in both serum copper and ceruloplasmin. Copper supplementation also improved her iron status as assessed by transferrin saturation and ferritin. Clinicians should monitor both zinc and copper status in anemic dialysis patients during zinc supplementation, as both are important to drive normal hematopoiesis.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ESA:

Erythropoiesis-stimulating agent

CRP:

C-reactive protein

DMT1:

Divalent metal transporter 1

CTR1:

Copper transporter 1

ATP7A:

ATPase copper transporting alpha

ZIP4:

Zrt/Irt-like protein 4

ZnT1:

Zinc transporter 1

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Acknowledgements

We thank the dialysis staff at Ikeda Clinic.

Funding

No funding was obtained for this case report.

Author information

Authors and Affiliations

  1. Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan

    Tomoka Watanabe & Tatsuo Tsukamoto

  2. Ikeda Clinic Osaka, 1-5-4 Katamachi, Miyakojima-ku, Osaka, 534-0025, Japan

    Satomi Yonemoto & Yoshihiro Ikeda

  3. Department of Gastroenterology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan

    Kiyotaka Kawaguchi

Authors
  1. Tomoka Watanabe
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  2. Satomi Yonemoto
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  3. Yoshihiro Ikeda
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  4. Kiyotaka Kawaguchi
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  5. Tatsuo Tsukamoto
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Contributions

TW wrote the manuscript with the support of TT. SY, HI, and KK treated the patient while being supported by TT. TW presented this case at the Sixty-eighth Japanese Society of Dialysis Therapy meeting.

Corresponding author

Correspondence to Tomoka Watanabe.

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The authors declare that they have no conflict of interests.

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The ethical committee of Kitano Hospital approved this case report.

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Informed consent was obtained from the patient in this case report.

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Watanabe, T., Yonemoto, S., Ikeda, Y. et al. Copper deficiency anemia due to zinc supplementation in a chronic hemodialysis patient. CEN Case Rep (2024). https://doi.org/10.1007/s13730-024-00862-6

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  • DOI: https://doi.org/10.1007/s13730-024-00862-6

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