The efficacy and safety of zinc gluconate supplementation on quality of life, sleep quality, and serum albumin in hemodialysis patients: A randomized clinical trial

Chronic kidney disease (CKD) is a condition where the removal of waste products, hemostasis of electrolytes, activation of vitamin D, and regulation of blood pressure are impaired. To compensate impaired renal function, waste products and excess water are removed from the blood through dialysis, including hemodialysis and peritoneal dialysis. Although hemodialysis mimics some functions of the kidney, it is not as effective as normal kidney. Indeed, patients on hemodialysis suffer from several problems, including decreased level of albumin, poor sleep quality, and low quality of life. Hemodialysis patients usually have less albumin than healthy individuals due to increased albumin excretion during hemodialysis. Also, synthesis of albumin is decreased in response to high inflammation and malnutrition among hemodialysis patients. Moreover, malnutrition is a cause of albumin synthesis reduction. Studies showed that some nutrients, such as zinc, may have favorable effect on albumin level, for instance, zinc supplementation resulted in increment of albumin in sever zinc deficient subjects. Poor sleep quality is another problem among hemodialysis patients. Another common problem in hemodialysis patients is low quality of life, which tends to be lower than healthy counterparts. Evidence confirm that zinc deficiency is prevalent among hemodialysis patients. Although zinc supplementation could putatively improve albumin level, sleep quality, and quality of life in previous studies, there is limited evidence regarding hemodialysis patients. Additionally, most previous studies used zinc supplement in the form of zinc sulfate, whilst the effect of zinc gluconate, a more digestible with less side effects form of zinc supplement, has not been examined.