Serum selenium levels are inversely associated with death risk among hemodialysis patients.

BACKGROUND Previous studies have indicated that serum selenium levels are decreased in hemodialysis patients. Selenium deficiency may contribute to an increased risk for death among hemodialysis patients. METHODS A population-based prospective cohort study in adult hemodialysis patients was conducted. A total of 1041 patients were enrolled. Patients were divided into quartile groups according to serum selenium levels. Mortality rates between the groups were compared by the log-rank test. Associations between serum selenium levels and cause-specific mortality risks in hemodialysis patients were examined by Cox's regression model. RESULTS A total of 382 patients died during the 5-year follow-up period (median follow-up period, 4.9 years). Crude mortality rates in quartile groups according to serum selenium levels were 134.5, 99.9, 85.9 and 55.2 (per 1000 patient-years), respectively. The lowest quartile group had significantly higher mortality rates from all-cause and infectious disease-related death than the rates in the other three groups (P < 0.001, by log-rank test). Mortality rates from cardiovascular and malignant disease-related death were similar between the groups. A strong inverse relationship between selenium levels and infectious disease-related death was observed even after multivariate adjustment (trend P = 0.024). CONCLUSIONS Serum selenium levels were inversely associated with death risk, especially death risk due to infectious disease, among hemodialysis patients. Decreased serum selenium level may contribute to immunity dysfunction and may increase the risk of death from infectious disease in hemodialysis patients.