Managing Zinc Supplementation in Hemodialysis Patients: Balancing and Preventing Deficiencies in Serum Copper and Zinc Levels with and Without HIF-PH Inhibitors

Zinc supplementation induces metallothionein, leading to reduced serum copper levels. Conversely, serum copper concentrations tend to rise with the use of HIF-PH inhibitors. To establish a safe level of zinc supplementation that avoids copper deficiency, serum copper and zinc concentrations measured every three months were retrospectively analyzed over five years in 50 patients undergoing hemodialysis. At the initiation of the study, the median (IQR) concentrations were 100 (84.25-109) µg/dL for serum copper and 60.5 (50.5-70) µg/dL for serum zinc. All participants without zinc supplementation exhibited zinc deficiency (