Serum zinc and copper levels in maintenance haemodialysis patients and its relationship with depression and anxiety

Hemodialysis (HD) patients are at risk for both deficiency, and accumulation of trace elements, although the data remains controversial. Low serum zinc level is associated with major depression in the general population; and copper interferes with zinc levels since it shares the same absorption pathways as zinc. Previous data suggest a possible zinc deficiency and copper excess is associated with depression in haemodialysis patients. The aims of this study are to assess depression and anxiety in HD patients using the Beck Depression Inventory and Beck Anxiety Inventory scoring system, and, to determine the association of serum zinc and copper levels with depression and anxiety in HD patients. A cross sectional study was conducted on 65 Haemodialysis patients stratified across equal numbers of study subjects relevant to age and sex; and compared to an apparently healthy cohort of individuals over a period of 3 months. All study subjects were analyzed for serum zinc, copper, urea, creatinine, haemoglobin and albumin after collecting detailed demographic data. Anxiety and depression were assessed by using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scoring system. The results of this study demonstrated that 89% and 98 % of haemodialysis patients suffered from depression and anxiety respectively. The mean levels of serum zinc and albumin were 56.25 ± 22.85 μg/dl vs 83.8 ± 18.12 μg/dl and 3.14 ± 0.49 gm/dl vs 3.95 ± 0.37 gm/dl respectively; which were significantly decreased in HD patients when compared to controls. A negative correlation was found between serum zinc levels and severity of depression; but, not for anxiety in HD patients. Serum copper levels in haemodialysis patients were indifferent from the controls (118.2 ± 41.59 μg/dl vs 102.23 ± 30 μg/dl). This study concluded that the majority of patients undergoing chronic haemodialysis were severely depressed and anxious. Patients on regular haemodialysis had decreased zinc levels and had more severe psychiatric disturbances than others