# Comparative analysis of blood trace elements in Egyptian hemodialysis patients and their relatives in the same geographical area, is dialysis still guilty?

## TL;DR

This study compares trace element levels in Egyptian hemodialysis patients and their relatives, finding environmental and health-related influences on element imbalances.

## Contribution

The study identifies specific trace element disturbances in hemodialysis patients linked to environmental and health factors.

## Key findings

- HD patients had elevated Ba and Mg levels, while relatives had higher Cr levels.
- Hypertensive individuals showed reduced Cr and elevated Ni and As levels.
- Zinc levels in HD patients were independently associated with hemoglobin levels.

## Abstract

Hemodialysis (HD) patients are at theoretical risk for deficiency of essential trace elements and excess potentially toxic elements. The present study aimed to evaluate the influence of environmental and geographical factors on these alterations.

This comparative cross-sectional study analyzed the blood concentrations of 22 trace elements in 137 participants (HD patients and their relatives) from the same geographical region. Dialysis and tap water samples were analyzed for the same trace elements panel. All samples underwent microwave-assisted acid digestion with nitric acid to ensure complete mineralization before inductively coupled plasma optical emission spectrometry analysis.

Trace element analysis indicated significantly elevated levels of Ba (p = 0.008) and Mg (p = 0.028) in HD patients, while Cr (p = 0.013) was significantly higher in their relatives. Other trace elements exhibited no significant differences. Hypertensive individuals exhibited reduced Cr (p = 0.038), and elevated Ni (p = 0.029), and As (p = 0.005) levels, whereas diabetics demonstrated decreased Cr (p = 0.001), and increased Pb (p = 0.032) concentrations. Urban populations exhibited elevated Ni levels (p = 0.02) while rural populations showed increased As levels (p = 0.03). People living near plastic factories showed markedly higher blood Al levels (p = 0.048). The whole blood Zn concentration was an independent predictor of blood hemoglobin level (p = 0.023) in HD patients.

This study demonstrates significant disturbances in trace element balance among HD patients, partly linked to environmental exposures and associated with potential adverse outcomes. Future multicenter studies using advanced analytical techniques and strategies to modify environmental risk factors are warranted to support evidence-based, personalized interventions that improve long-term patient outcomes.

The online version contains supplementary material available at 10.1186/s12882-025-04636-9.