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Nutrition in acute and chronic diseases

Relationship of serum copper and zinc with kidney function and urinary albumin to creatinine ratio: Cross-sectional data from the NHANES 2011–2016


Background & objective

Chronic kidney disease (CKD) is a common condition in worldwide with underlying causes. The role of trace elements such as copper and zinc in CKD is uncertain. We aimed to examine the relationship of serum copper and zinc with kidney function status and explore its possible effect modifiers in the general population.


Data from 5353 National Health and Nutrition Examination Survey (NHANES) participants from 2011 to 2016 were analyzed for the role of trace elements in the age range 18 to 80 years. The kidney outcomes were reduced estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and increased urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g.


Findings showed a significant positive association between serum copper and urinary ACR (OR = 1.04, 95% CI = 1.00–1.07). Serum copper levels of 18.0 μmol/L (median) or higher (reference level <18.0 μmol/L) were significantly associated with increased urinary ACR (OR = 1.67, 95% CI = 1.21–2.31) after adjusting for confounding factors. In contrast, there was a significant inverse association between serum zinc and reduced eGFR (OR = 0.89,95% CI = 0.81–0.99). Where serum zinc level was greater than 12.3 μmol/L (median), the prevalence of reduced eGFR was lower (OR = 0.65, 95% CI = 0.16–0.60). In addition, a stratified analysis based on various risk factors found that in those individuals with serum albumin greater than 43 g/L or systolic blood pressure greater than 120 mmHg, positive correlations between serum copper and risk of increased urinary ACR was more significant.


Our findings suggest that the reference levels of serum copper and zinc levels in healthy individuals may be different from current understanding. If further studies substantiate the same, the results will be a useful guide for designing future clinical trials and nutritional guidelines.

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Fig. 1: Multivariate adjusted association between serum zinc and copper concentrations and kidney function status*.
Fig. 2: Stratified analysis for the kidney outcomes and trace elements in various subgroups*.

Data availability

The datasets analysed during the current study are available in the National Health and Nutrition Examination Survey repository, [].


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The authors thank the investigators and participants of the National Health and Nutrition Examination Survey, which made this report possible.


This work was supported by High Level-Hospital Program, Health Commission of Guangdong Province, China (HKUSZH20192026).

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CJ and GW designed the research; CJ analyzed the data; CJ and HY wrote the paper. All authors contributed to data collection and reviewed/edited the manuscript for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Gang Wang.

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Jiang, C., Ye, H., Cui, L. et al. Relationship of serum copper and zinc with kidney function and urinary albumin to creatinine ratio: Cross-sectional data from the NHANES 2011–2016. Eur J Clin Nutr (2022).

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