U-Shaped Association between Whole Blood Selenium and Cancer Mortality in U.S. Adults with Chronic Kidney Disease: A NHANES-Based Cohort Study
DOI:
https://doi.org/10.54097/httvb556Keywords:
Chronic Kidney Disease, Whole Blood Selenium, NHANES, Cancer, MortalityAbstract
Background: Chronic kidney disease (CKD) is accompanied by a substantial burden of cancer-related death, but the prognostic role of selenium in this setting is not well defined. Previous CKD studies have focused mainly on serum selenium and composite outcomes. Whether whole-blood selenium has a nonlinear relation with cancer mortality has not been established. We therefore examined this association in U.S. adults with non-dialysis-dependent CKD. Methods: We conducted a retrospective cohort study using NHANES 2013–2018 data. The analysis included 1,941 adults with non-dialysis-dependent CKD (928 men and 1,013 women). Baseline whole-blood selenium was measured by inductively coupled plasma mass spectrometry. Cancer mortality was the primary endpoint; all-cause and cardiovascular mortality were secondary endpoints, identified by National Death Index linkage through December 31, 2019. Weighted Cox models and restricted cubic splines were used, with recursive procedures applied to locate a possible change point. Results: Over a median follow-up of 33.0 months, 40 participants died from cancer, 218 died from any cause, and 79 died from cardiovascular disease. The spline model supported a U-shaped cancer-mortality curve (P for non-linearity = 0.026), with the lowest estimated risk at 236.4 μg/L. Below that value, each 1 μg/L increment corresponded to a 1.6% lower cancer-mortality hazard (HR 0.984, 95% CI 0.969–0.998); above it, the hazard rose by 1.6% per increment (HR 1.016, 95% CI 1.008–1.028). Selenium deficiency (<173.2 μg/L) was associated with higher all-cause mortality (HR 1.627, 95% CI 1.212–2.183). Conclusions: In this NHANES CKD cohort, whole-blood selenium was related to cancer mortality in a U-shaped pattern rather than a simple linear gradient. The estimated turning point was 236.4 μg/L. Because the study is observational and cancer deaths were few, these values should be treated as hypothesis-generating and tested in prospective studies before being used to guide supplementation.
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