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Yin Y, Zhao C, Niu Y, Qi J, Zhang Y, Lu B. Associations between oxidative balance score and chronic kidney disease events in US adults: a population-based study. Sci Rep 2024; 14:13743. [PMID: 38877058 PMCID: PMC11178767 DOI: 10.1038/s41598-024-64147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
Oxidative Balance Scores (OBS) are utilized to assess an individual's antioxidant status, encompassing both dietary and lifestyle factors that contribute to oxidative balance. This study investigates the relationship between OBS and chronic kidney disease (CKD) prevalence among U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The study involved a cross-sectional analysis of 13,373 individuals from NHANES, focusing on adults aged 20 years or older. OBS was calculated using 20 components, including dietary and lifestyle factors. CKD was identified based on albumin-to-creatinine ratio and estimated glomerular filtration rate, with patients stratified into mild, moderate, and high-risk groups. Statistical analysis included logistic regression models and restricted cubic splines to explore the OBS-CKD relationship. Our findings indicate a statistically significant negative correlation between OBS and CKD prevalence, particularly in mild and moderate-risk groups. Higher OBS quartiles were associated with a decreased likelihood of CKD (OR 0.70; 95% CI 0.53-0.92; P = 0.013). Restricted cubic splines indicated a non-linear, inverse association between OBS and CKD odds for the overall population (P for nonlinearity = 0.017). For mild and moderate CKD risk groups, the relationships were less pronounced (P for nonlinearity = 0.053 and 0.184, respectively), suggesting variability in the OBS-CKD link across different risk levels. The study highlights the potential of elevated OBS as a primary prevention measure for CKD, particularly in individuals with mild to moderate risk. These findings underscore the importance of antioxidant status in CKD risk management and encourage further research into the role of dietary and lifestyle factors in CKD prevention.
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Affiliation(s)
- Yuewei Yin
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Chenming Zhao
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yalin Niu
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jinchun Qi
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yanping Zhang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Baosai Lu
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Zaman SU, Rafiq S, Ali A, Mehdi MS, Arshad A, Rehman SU, Muhammad N, Irfan M, Khurram MS, Zaman MKU, Hanbazazah AS, Lim HR, Show PL. Recent advancement challenges with synthesis of biocompatible hemodialysis membranes. CHEMOSPHERE 2022; 307:135626. [PMID: 35863415 DOI: 10.1016/j.chemosphere.2022.135626] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 05/27/2023]
Abstract
The focus of this study is to enhance the protein fouling resistance, hydrophilicity, biocompatibility, hemocompatibility and ability of the membranes and to reduce health complications like chronic pulmonary disease, peripheral vascular disease, cerebrovascular disease, and cardiovascular disease after dialysis, which are the great challenges in HD applications. In the current study, the PSF-based dialysis membranes are studied broadly. Significant consideration has also been provided to membrane characteristics (e.g., flowrate coefficient, solute clearance characteristic) and also on commercially available polysulfone HD membranes. PSF has gained a significant share in the development of HD membranes, and continuous improvements are being made in the process to make high flux PSF-based dialysis membranes with enhanced biocompatibility and improved protein resistance ability as the major issue in the development of membranes for HD application is biocompatibility. There has been a great increase in the demand for novel biocompatible membranes that offer the best performances during HD therapy, for example, low oxidative stress and low change ability of blood pressure.
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Affiliation(s)
- Shafiq Uz Zaman
- Department of Chemical Engineering, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi, Khyber Pakhtunkhwa, Pakistan.
| | - Sikander Rafiq
- Department of Chemical Polymer and Composite Materials Engineering, University of Engineering and Technology Lahore, New Campus, Pakistan.
| | - Abulhassan Ali
- Department of Chemical Engineering, University of Jeddah, Jeddah, Saudi Arabia.
| | - Muhammad Shozab Mehdi
- Department of Chemical Engineering, Ghulam Ishaq Khan Institute of Engineering Sciences and Technology, Topi, Khyber Pakhtunkhwa, Pakistan.
| | - Amber Arshad
- Department of Community Medicine, King Edward Medical University, Lahore, Pakistan.
| | - Saif-Ur Rehman
- Department of Chemical Engineering, COMSATS University Islamabad, Lahore Campus, Pakistan.
| | - Nawshad Muhammad
- Department of Dental Materials, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Muhammad Irfan
- Centre of Environmental Sustainability and Water Security (IPASA), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia.
| | | | | | - Abdulkader S Hanbazazah
- Department of Industrial and Systems Engineering, University of Jeddah, Jeddah, Saudi Arabia.
| | - Hooi Ren Lim
- Department of Chemical and Environmental Engineering, Faculty Science and Engineering, University of Nottingham, Malaysia, 43500, Semenyih, Selangor Darul Ehsan, Malaysia.
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty Science and Engineering, University of Nottingham, Malaysia, 43500, Semenyih, Selangor Darul Ehsan, Malaysia.
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3
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Ohba K, Miyata Y, Shinzato T, Funakoshi S, Maeda K, Matsuo T, Mitsunari K, Mochizuki Y, Nishino T, Sakai H. Effect of oral intake of royal jelly on endothelium function in hemodialysis patients: study protocol for multicenter, double-blind, randomized control trial. Trials 2021; 22:950. [PMID: 34930416 PMCID: PMC8690339 DOI: 10.1186/s13063-021-05926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background Hemodialysis (HD) is a common renal replacement therapy for patients with renal failure. Cardiovascular and cerebrovascular diseases are known to shorten survival periods and worsen the quality of life of HD patients. Atherosclerosis is a major cause of vascular diseases, and various factors such as abnormality of lipid metabolism and increased macrophage activity, oxidative stress, and endothelial dysfunction are associated with its pathogenesis and progression. Further, endothelial stem cells (ESCs) have been reported to play important roles in endothelial functions. Royal jelly (RJ) affects atherosclerosis- and endothelial function-related factors. The main aim of this trial is to investigate whether oral intake of RJ can maintain endothelial function in HD patients. In addition, the effects of RJ intake on atherosclerosis, ESC count, inflammation, and oxidative stress will be analyzed. Methods This will be a multicenter, prospective, double-blind, randomized controlled trial. We will enroll 270 participants at Nagasaki Jin Hospital, Shinzato Clinic Urakami, and Maeda Clinic, Japan. The participants will be randomized into RJ and placebo groups. The trial will be conducted according to the principles of the Declaration of Helsinki, and all participants will be required to provide written informed consent. The RJ group will be treated with 3600 mg/day of RJ for 24 months, and the placebo group will be treated with starch for 24 months. The primary endpoint will be the change in flow-mediated dilation (FMD), a parameter of endothelium function, from the time before treatment initiation to 24 months after treatment initiation. The secondary and other endpoints will be changes in FMD; ESC count; serum levels of vascular endothelial cell growth factor, macrophage colony-stimulating factor, 8-hydroxydeoxyguanosine, and malondialdehyde; the incidence of cardiovascular diseases, cerebrovascular diseases, and stenosis of blood access; and safety. Discussion This trial will clarify whether oral intake of RJ can maintain endothelial function and suppress the progression of atherosclerosis in HD patients. In addition, it will clarify the effects of RJ on ESCs, oxidative stress, and angiogenic activity in blood samples. Trial registration The Japan Registry of Clinical Trials jRCTs071200031. Registered on 7 December 2020.
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Affiliation(s)
- Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yasuyoshi Miyata
- Department of Urology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takeaki Shinzato
- Shinzato Clinic Urakami, 3-20 Mori-machi, Nagasaki, 852-8104, Japan
| | | | - Kanenori Maeda
- Maeda Clinic, 587-2 Shinden-machi, Shimabara, 855-0043, Japan
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kensuke Mitsunari
- Department of Urology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yasushi Mochizuki
- Department of Urology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomoya Nishino
- Second Department of Internal Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Tomás-Simó P, D’Marco L, Romero-Parra M, Tormos-Muñoz MC, Sáez G, Torregrosa I, Estañ-Capell N, Miguel A, Gorriz JL, Puchades MJ. Oxidative Stress in Non-Dialysis-Dependent Chronic Kidney Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157806. [PMID: 34360098 PMCID: PMC8345537 DOI: 10.3390/ijerph18157806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/22/2022]
Abstract
Background: Cardiovascular complications are the leading cause of morbidity and mortality at any stage of chronic kidney disease (CKD). Moreover, the high rate of cardiovascular mortality observed in these patients is associated with an accelerated atherosclerosis process that likely starts at the early stages of CKD. Thus, traditional and non-traditional or uremic-related factors represent a link between CKD and cardiovascular risk. Among non-conventional risk factors, particular focus has been placed on anaemia, mineral and bone disorders, inflammation, malnutrition and oxidative stress and, in this regard, connections have been reported between oxidative stress and cardiovascular disease in dialysis patients. Methods: We evaluated the oxidation process in different molecular lines (proteins, lipids and genetic material) in 155 non-dialysis patients at different stages of CKD and 45 healthy controls. To assess oxidative stress status, we analyzed oxidized glutathione (GSSG), reduced glutathione (GSH) and the oxidized/reduced glutathione ratio (GSSG/GSH) and other oxidation indicators, including malondialdehyde (MDA) and 8-oxo-2’-deoxyguanosine (8-oxo-dG). Results: An active grade of oxidative stress was found from the early stages of CKD onwards, which affected all of the molecular lines studied. We observed a heightened oxidative state (indicated by a higher level of oxidized molecules together with decreased levels of antioxidant molecules) as kidney function declined. Furthermore, oxidative stress-related alterations were significantly greater in CKD patients than in the control group. Conclusions: CKD patients exhibit significantly higher oxidative stress than healthy individuals, and these alterations intensify as eGFR declines, showing significant differences between CKD stages. Thus, future research is warranted to provide clearer results in this area.
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Affiliation(s)
- Patricia Tomás-Simó
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
| | - Luis D’Marco
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
- Correspondence: (L.D.); (M.J.P.); Tel.: +34-961973500 (ext. 436443) (M.J.P.)
| | - María Romero-Parra
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
| | - Mari Carmen Tormos-Muñoz
- Service of Clinical Analysis, Department of Biochemistry and Molecular Biology, Facultad de Medicina y Odontología-INCLIVA, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46010 Valencia, Spain; (M.C.T.-M.); (G.S.); (N.E.-C.)
| | - Guillermo Sáez
- Service of Clinical Analysis, Department of Biochemistry and Molecular Biology, Facultad de Medicina y Odontología-INCLIVA, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46010 Valencia, Spain; (M.C.T.-M.); (G.S.); (N.E.-C.)
| | - Isidro Torregrosa
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
| | - Nuria Estañ-Capell
- Service of Clinical Analysis, Department of Biochemistry and Molecular Biology, Facultad de Medicina y Odontología-INCLIVA, Hospital Universitario Dr. Peset, FISABIO, Universidad de Valencia, 46010 Valencia, Spain; (M.C.T.-M.); (G.S.); (N.E.-C.)
| | - Alfonso Miguel
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
| | - José Luis Gorriz
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
| | - María Jesús Puchades
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (P.T.-S.); (M.R.-P.); (I.T.); (A.M.); (J.L.G.)
- Correspondence: (L.D.); (M.J.P.); Tel.: +34-961973500 (ext. 436443) (M.J.P.)
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5
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Ghafouri A, hajiluian G, karegar SJ, Hosseini S, Shidfar S, Kamalinejad M, AghaHosseini F, Heydari I, Shidfar F. The effect of Aqueous, Ethanolic extracts of Rheum ribeson insulin sensitivity, inflammation, oxidative stress in patients with type 2 diabetes mellitus: A Randomized, Double-Blind, Placebo-Controlled Trial. J Herb Med 2020. [DOI: 10.1016/j.hermed.2020.100389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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6
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Kohlová M, Rocha S, Gomes Amorim C, de Nova Araújo A, Santos-Silva A, Solich P, Branco da Silva Montenegro MC. Doping Polysulfone Membrane with Alpha-Tocopherol and Alpha-Lipoic Acid for Suppressing Oxidative Stress Induced by Hemodialysis Treatment. Macromol Biosci 2020; 20:e2000046. [PMID: 32543121 DOI: 10.1002/mabi.202000046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/14/2020] [Indexed: 11/07/2022]
Abstract
The reduction of free radicals by bioactive membranes used for hemodialysis treatment is an important topic due to the constant rise of oxidative stress-associated cardiovascular mortality by hemodialysis patients. Therefore, it is urgent to find an effective solution that helps to solve this problem. Polysulfone membranes enriched with α-lipoic acid, α-tocopherol, and with both components are fabricated by spin coating. The antioxidant properties of these membranes are evaluated in vitro by determining the lipid-peroxidation level and the total antioxidant status of the blood plasma. The biocompatibility is assessed by quantifying the protein adsorption, platelet adhesion, complement activation, and hemolytic effect. All types of membranes show in vitro antioxidant activity and a trend to reduce oxidative stress in vivo; the best results show membranes prepared with a combination of both compounds and prove to be nonhemolytic and hemocompatible. Moreover, the membrane specific separation ability for the main waste products is not affected by antioxidants incorporation.
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Affiliation(s)
- Michaela Kohlová
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal.,Department of Analytical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
| | - Susana Rocha
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Célia Gomes Amorim
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Alberto de Nova Araújo
- LAQV-REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Alice Santos-Silva
- UCIBIO-REQUIMTE, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, Porto, 4050-313, Portugal
| | - Petr Solich
- Department of Analytical Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, Hradec Králové, 500 05, Czech Republic
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7
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Larsen EL, Weimann A, Poulsen HE. Interventions targeted at oxidatively generated modifications of nucleic acids focused on urine and plasma markers. Free Radic Biol Med 2019; 145:256-283. [PMID: 31563634 DOI: 10.1016/j.freeradbiomed.2019.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022]
Abstract
Oxidative stress is associated with the development and progression of numerous diseases. However, targeting oxidative stress has not been established in the clinical management of any disease. Several methods and markers are available to measure oxidative stress, including direct measurement of free radicals, antioxidants, redox balance, and oxidative modifications of cellular macromolecules. Oxidatively generated nucleic acid modifications have attracted much interest due to the pre-mutagenic oxidative modification of DNA into 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), associated with cancer development. During the last decade, the perception of RNA has changed from that of a 'silent messenger' to an 'active contributor', and, parallelly oxidatively generated RNA modifications measured as 8-oxo-7,8-dihydro-guanosine (8-oxoGuo), has been demonstrated as a prognostic factor for all-caused and cardiovascular related mortality in patients with type 2 diabetes. Several attempts have been made to modify the amount of oxidative nucleic acid modifications. Thus, this review aims to introduce researchers to the measurement of oxidatively generated nucleic acid modifications as well as critically review previous attempts and provide future directions for targeting oxidatively generated nucleic acid modifications.
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Affiliation(s)
- Emil List Larsen
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
| | - Allan Weimann
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Liakopoulos V, Roumeliotis S, Zarogiannis S, Eleftheriadis T, Mertens PR. Oxidative stress in hemodialysis: Causative mechanisms, clinical implications, and possible therapeutic interventions. Semin Dial 2018; 32:58-71. [PMID: 30288786 DOI: 10.1111/sdi.12745] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Oxidative stress (OS) is the result of prooxidant molecules overwhelming the antioxidant defense mechanisms. Hemodialysis (HD) constitutes a state of elevated inflammation and OS, due to loss of antioxidants during dialysis and activation of white blood cells triggering production of reactive oxygen species. Dialysis vintage, dialysis methods, and type and condition of vascular access, biocompatibility of dialyzer membrane and dialysate, iron administration, and anemia all can play a role in aggravating OS, which in turn has been associated with increased morbidity and mortality. Oral or intravenous administration of antioxidants may detoxify the oxidative molecules and at least in part repair OS-mediated tissue damage. Lifestyle interventions and optimization of a highly biocompatible HD procedure might ameliorate OS development in dialysis.
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Affiliation(s)
- Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Zarogiannis
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theodoros Eleftheriadis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
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9
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Bufano G, Usberti M, Mandolfo S, Malberti F, Piroddi M, Galli F. Von Willebrand Factor and Autoantibodies against Oxidized LDL in Hemodialysis Patients Treated with Vitamin E-Modified Dialyzers. Int J Artif Organs 2018; 27:214-21. [PMID: 15112887 DOI: 10.1177/039139880402700308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oxidant stress is a well known cause of damage in the atherosclerotic process. Vitamin E is one of the most promising natural antioxidants. In this study we investigated if a vitamin E-coated dialyzer was able to reduce the plasma levels of auto-antibodies against oxidized-LDL, von Willebrand factor (vWf) and thrombomodulin (TM) as markers of endothelial damage. In this controlled 6-month prospective study, we investigated these markers in two matched groups (n= 16 each) of patients on regular hemodialysis not yet diagnosed for atherosclerosis cardiovascular disease (ACVD) (mean age= 58.3±7.0 yrs, mean dialysis age = 30.1±10.0 months), in which cellulosic (CLS) and vitamin E-modified dialyzers (CLE) were compared. At inclusion all the patients were treated with CLS. Then, the study group was shifted to CLE for 6 months. At baseline the patients showed normal levels of vitamin E and high levels of oxLDL-Ab, vWf and TM compared to healthy subjects. In the CLE group oxLDL-Ab and vWf, but not TM levels, decreased progressively (from 472±287 to 264±199 mU/mL, p<0.0001 and from 101.1±7.5% to 76.7±18.5%; p<0.001, respectively), and vitamin E increased from 4.40±0.81 to 7.81±1.16 μg/mg of cholesterol. At the end of the study, 8 of the patients treated with CLE were randomly selected and went back to the membrane without Vitamin E for six months. They showed an significant increase in OxLDL-Ab and vWf levels and a significant reduction in tocoferol levels. In conclusion, CLE compared to cellulosic dialyzers can lower some indices of damage to LDL and endothelial cells.
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Affiliation(s)
- G Bufano
- Division of Nephrology and Dialysis, Cremona Hospital, Italy.
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10
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Oxidative Stress in Hemodialysis Patients: A Review of the Literature. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:3081856. [PMID: 29138677 PMCID: PMC5613374 DOI: 10.1155/2017/3081856] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
Hemodialysis (HD) patients are at high risk for all-cause mortality and cardiovascular events. In addition to traditional risk factors, excessive oxidative stress (OS) and chronic inflammation emerge as novel and major contributors to accelerated atherosclerosis and elevated mortality. OS is defined as the imbalance between antioxidant defense mechanisms and oxidant products, the latter overwhelming the former. OS appears in early stages of chronic kidney disease (CKD), advances along with worsening of renal failure, and is further exacerbated by the HD process per se. HD patients manifest excessive OS status due to retention of a plethora of toxins, subsidized under uremia, nutrition lacking antioxidants and turn-over of antioxidants, loss of antioxidants during renal replacement therapy, and leukocyte activation that leads to accumulation of oxidative products. Duration of dialysis therapy, iron infusion, anemia, presence of central venous catheter, and bioincompatible dialyzers are several factors triggering the development of OS. Antioxidant supplementation may take an overall protective role, even at early stages of CKD, to halt the deterioration of kidney function and antagonize systemic inflammation. Unfortunately, clinical studies have not yielded unequivocal positive outcomes when antioxidants have been administered to hemodialysis patients, likely due to their heterogeneous clinical conditions and underlying risk profile.
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11
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Rodríguez-Ribera L, Corredor Z, Silva I, Díaz JM, Ballarín J, Marcos R, Pastor S, Coll E. Vitamin E-coated dialysis membranes reduce the levels of oxidative genetic damage in hemodialysis patients. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2017; 815:16-21. [PMID: 28283088 DOI: 10.1016/j.mrgentox.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 01/15/2023]
Abstract
End-stage renal disease patients present oxidative stress status that increases when they are submitted to hemodialysis (HD). This increase in oxidative stress can affect their genetic material, among other targets. The objective of this study was to evaluate the effect of using polysulfone membranes coated with vitamin E, during the HD sessions, on the levels of genetic damage of HD patients. Forty-six patients were followed for 6 months, of whom 29 changed from conventional HD to the use of membranes coated with vitamin E. The level of genetic damage was measured using the micronucleus and the comet assays, both before and after the follow-up period. Serum vitamin E concentration was also checked. The obtained results showed that 24% of our patients presented vitamin E deficiency, and this was normalized in those patients treated with vitamin E-coated membranes. Patients with vitamin E deficiency showed higher levels of oxidative DNA damage. After the use of vitamin E-coated membranes we detected a significant decrease in the levels of oxidative damage. Additionally, hemoglobin values increased significantly with the use of vitamin E-coated membranes. In conclusion, the use of vitamin E-coated membranes supposes a decrease on the levels of oxidative DNA damage, and improves the uremic anemia status. Furthermore, the use of this type of membrane was also effective in correcting vitamin E deficiency.
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Affiliation(s)
- Lara Rodríguez-Ribera
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici C, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Zuray Corredor
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici C, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | | | | | | | - Ricard Marcos
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici C, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain; CIBER Epidemiología y Salud Pública, ISCIII, Madrid, Spain
| | - Susana Pastor
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici C, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain; CIBER Epidemiología y Salud Pública, ISCIII, Madrid, Spain.
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Kokubo K, Kurihara Y, Kobayashi K, Tsukao H, Kobayashi H. Evaluation of the Biocompatibility of Dialysis Membranes. Blood Purif 2015; 40:293-7. [PMID: 26656534 DOI: 10.1159/000441576] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Improvements in the biocompatibility of dialysis membranes have reduced biological responses elicited by blood-membrane interactions. In this article, recent technological developments in dialysis membranes with regard to biocompatibility and recent progress in the evaluation of the biocompatibility of dialysis membranes are reviewed. SUMMARY The focus of investigation into dialysis membranes in recent years has focused on not only membrane materials, but also their surface textures, which have been changed, for example, by coating with vitamin E or by changing the amount and type of hydrophilizing agents used. Research and development is directed at altering the chemical and physical properties of membrane surfaces to suppress biological responses that are particularly elicited as a result of platelet activation. To develop membranes with excellent biocompatibility, biocompatibility should be evaluated on a like-for-like basis under conditions that are similar to those in clinical settings. Evaluation using actual dialyzers can be performed using porcine blood, platelet-rich plasma isolated from porcine blood (and platelet-rich plasma with leukocytes), or suspension of neutrophils isolated from porcine blood or cultured human monocytes. KEY MESSAGES Highly biocompatible dialysis membranes can be developed when the overall correlations among biological reactions are examined by integrating all data on biological responses elicited by blood-membrane interactions or mutual interactions among blood cells.
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Affiliation(s)
- Kenichi Kokubo
- Kitasato University School of Allied Health Sciences, Kanagawa, Japan
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13
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Ilori TO, Sun Ro Y, Kong SY, Gutierrez OM, Ojo AO, Judd SE, Narayan KMV, Goodman M, Plantinga L, McClellan W. Oxidative Balance Score and Chronic Kidney Disease. Am J Nephrol 2015; 42:320-7. [PMID: 26569393 DOI: 10.1159/000441623] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/18/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The oxidative balance score (OBS) is a composite estimate of the overall pro- and antioxidant exposure status in an individual. The aim of this study was to determine the association between OBS and renal disease. METHODS Using the Reasons for Geographic and Racial Differences in Stroke cohort study, OBS was calculated by combining 13 a priori-defined pro- and antioxidant factors by using baseline dietary and lifestyle assessment. OBS was divided into quartiles (Q1-Q4) with the lowest quartile, Q1 (predominance of pro-oxidants), as the reference. Multivariable logistic regression and Cox proportional hazards models were used to estimate adjusted ORs for albuminuria defined as urine albumin/creatinine ratio (ACR)>30 mg/g, macroalbuminuria defined as ACR>300 mg/g and chronic kidney disease (CKD) defined as estimated glomerular filtration rate<60 ml/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration and hazards ratios for end-stage renal disease (ESRD), respectively. RESULTS Of the 19,461 participants analyzed, 12.9% had albuminuria and 10.1% had CKD at baseline; over a median follow-up of 3.5 years (range 2.14-4.32 years), 0.46% developed ESRD. Higher OBS quartiles were associated with lower prevalence of CKD (OR vs. Q1: Q2=0.93 [95% CI 0.80-1.08]; Q3=0.90 [95% CI 0.77-1.04] and Q4=0.79 [95% CI 0.67-0.92], p for trend<.01). The associations between OBS and albuminuria (p for trend 0.31) and incident ESRD (p for trend 0.56) were not significant in the fully adjusted models. CONCLUSIONS These findings suggest that higher OBS is associated with lower prevalence of CKD. Lack of association with ESRD incidence in the multivariable analyses indicates that temporal relation between OBS and renal damage remains unclear.
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Chang T, Neelakandan C, Kyu T, Tseng YT, DeFine L, Alexander T. Asymmetric porous membranes formed by coagulation-induced phase separation in poly(ether sulfone)/poly(vinyl pyrrolidone)/genistein blends. POLYMER 2014. [DOI: 10.1016/j.polymer.2014.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Kosmadakis G, Da Costa Correia E, Carceles O, Somda F, Aguilera D. Vitamins in dialysis: who, when and how much? Ren Fail 2014; 36:638-50. [DOI: 10.3109/0886022x.2014.882714] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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16
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Kitamura Y, Kamimura K, Yoshioka N, Hosotani Y, Tsuchida K, Koremoto M, Minakuchi J. The effect of vitamin E-bonded polysulfone membrane dialyzer on a new oxidative lipid marker. J Artif Organs 2013; 16:206-10. [PMID: 23397123 PMCID: PMC3684714 DOI: 10.1007/s10047-013-0689-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 01/21/2013] [Indexed: 11/04/2022]
Abstract
The use of vitamin E-bonded cellulose membrane dialyzers has been reported to cause a decrease in oxidative lipid marker levels (Nakai et al., Ther Apher Dial 14:505-540, 1; Nakai et al., J Jpn Soc Dial Ther 45:1-47, 2; Mashiba et al., Arterioscler Thromb Vasc Biol 21:1801-1808, 3). However, few studies have identified this effect with vitamin E-bonded polysulfone membranes, and no studies report the same effect on alpha (1) antitrypsin-LDL complex, a new oxidative lipid marker. This prompted us to examine the influence of use of VPS-HA vitamin E-bonded polysulfone high-flux membrane dialyzers on this new oxidative lipid marker. The subjects were 17 patients who had been dialyzed with VPS-HA for 12 months. The subjects' baseline characteristics were as follows. Their average age was 65.6 ± 13.1 years, comprising 8 males and 9 females; hemodialysis vintage was 83.8 ± 85.4 months. Eight had chronic glomerular nephropathy and five had diabetic nephropathy. The primary outcome was defined as alpha (1) antitrypsin-LDL complex level after 12 months, as a post-study using VPS-HA. Secondary outcomes included triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol levels. The data were analyzed pre-study and after 3, 6, 9 and 12 months for alpha (1) antitrypsin-LDL complex, and pre-study and post-study for the other indicators. Twelve months after switching to VPS-HA, alpha (1) antitrypsin-LDL complex, total cholesterol and LDL cholesterol had significantly decreased. Triglycerides and HDL cholesterol had not significantly changed. Hemodialysis therapy with VPS-HA was shown to decrease alpha (1) antitrypsin-LDL complex, an index of oxidative stress, and also to decrease some lipid markers.
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Affiliation(s)
- Yuki Kitamura
- />Department of Kidney Disease (Dialysis and Kidney Transplantation), Kawashima Hospital, Tokushima, Japan
- />Department of Urology, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Kumi Kamimura
- />Clinical Engineering, Kawashima Hospital, Tokushima, Japan
| | - Noriko Yoshioka
- />Clinical Engineering, Kawashima Hospital, Tokushima, Japan
| | - Yoko Hosotani
- />Clinical Engineering, Kawashima Hospital, Tokushima, Japan
| | - Kenji Tsuchida
- />Department of Kidney Disease (Dialysis and Kidney Transplantation), Kawashima Hospital, Tokushima, Japan
| | - Masahide Koremoto
- />Scientific and Technical Affairs Department, Asahi Kasei Medical Co., Ltd., 1-105 Kanda Jinbocho, Chiyoda-ku, Tokyo, 101-8101 Japan
| | - Jun Minakuchi
- />Department of Kidney Disease (Dialysis and Kidney Transplantation), Kawashima Hospital, Tokushima, Japan
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Mima A, Matsubara T, Endo S, Murakami T, Hashimoto Y. Use of a polysulfone hemodialysis membrane may prevent recurrent posterior reversible encephalopathy syndrome in a patient undergoing hemodialysis. Int Urol Nephrol 2013; 46:255-60. [DOI: 10.1007/s11255-013-0434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/27/2013] [Indexed: 11/24/2022]
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Tsukao H, Kokubo K, Takahashi H, Nagasato M, Endo T, Iizuka N, Shinbo T, Hirose M, Kobayashi H. Activation of platelets upon contact with a vitamin E-coated/non-coated surface. J Artif Organs 2013; 16:193-205. [PMID: 23381644 DOI: 10.1007/s10047-013-0686-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 01/11/2013] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine the effects of a vitamin E-coated surface on platelet activation, focusing on the interactions among the vitamin E-coated surface, platelets and leukocytes. Platelet-rich plasma (PRP) or PRP containing leukocytes (LPRP) was used. No difference was observed in platelet activation between PRP and LPRP for a vitamin E-coated membrane, meaning that platelet activation triggered by leukocytes was suppressed in plasma coming in contact with a vitamin E-coated membrane, while the membrane itself directly induced platelet activation. The antioxidant capacity of the vitamin E-coated membrane in contact with PRP or LPRP was partially reduced, but sufficient residual capacity remained. The in vitro experiments using an oxidized vitamin E-coated surface revealed that P-selectin expression and superoxide anion production in the platelets and platelet adhesion were induced by contact with the oxidized vitamin E-coated surface. We conclude that contact with a vitamin E-coated surface reduces platelet activation mediated by superoxide anions, probably by reducing superoxide anions, but during the process of the reduction, the vitamin E-coated surface itself becomes oxidized, which again causes platelet activation. The beneficial effects of a vitamin E-coated dialyzer in respect of platelet activation were counteracted by the formation of oxidized vitamin E.
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Affiliation(s)
- Hiroshi Tsukao
- Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
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Tucker PS, Dalbo VJ, Han T, Kingsley MI. Clinical and research markers of oxidative stress in chronic kidney disease. Biomarkers 2013; 18:103-15. [PMID: 23339563 DOI: 10.3109/1354750x.2012.749302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Kidney-related pathologies have increasing prevalence rates, produce a considerable financial burden, and are characterized by elevated levels of oxidative stress (OS). OBJECTIVE This review examines relationships between chronic kidney disease (CKD) and markers of OS and antioxidant status (AS). METHODS A systematic review of MEDLINE-indexed clinical trials, randomized controlled trials and comparative studies that examined OS and AS was performed. RESULTS AND CONCLUSION Several markers emerged as well-suited indicators of OS and AS in CKD: malondialdehyde, F2-isoprostanes, lipid hydroperoxides, asymmetric dimethylarginine, 8-oxo-7,8-dihydro-2'-deoxyguanosine, protein carbonyls, advanced oxidation protein products and glutathione-related activity.
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Affiliation(s)
- Patrick Steven Tucker
- Clinical Biochemistry Laboratory, Institute for Health and Social Science Research, Central Queensland University, Rockhampton, QLD, Australia
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Evaluation of the impact of a new synthetic vitamin E-bonded membrane on anemia and rHuEPO requirement in ESRD patients with central venous catheters: a pilot study. Int Urol Nephrol 2011; 44:1493-500. [PMID: 21960369 DOI: 10.1007/s11255-011-0016-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 06/02/2011] [Indexed: 01/27/2023]
Abstract
In the last years, the number of hemodialysis (HD) patients with erythropoietin (rHuEPO) resistance is increasing. Probably, central venous catheters (CVCs) contribute to this resistance by inducing inflammation and oxidative stress. This study was aimed to compare vitamin E-bonded dialyzer (PSVE) versus polyethersulfone membrane. Sixteen subjects with CVCs were included in a prospective two-arm crossover 12-month study. The primary endpoints were the rHuEPO requirement and the erythropoiesis-stimulating agents (ESA) index, which was defined by the ratio between weekly EPO dosage (IU/kg/week) and Hb levels (g/dl). The mean dosages of rHuEPO to maintain hemoglobin between 10.5 and 12 g/dl were 135 ± 59 and 101 ± 57 IU/kg/week with polysulfone and PSVE, respectively (P = 0.14). The ESA indexes were 12.1 ± 5.2 and 8.7 ± 5.2 (P < 0.0001) with polysulfone and PSVE, respectively. A trend towards consensual changes in protein glycoxidation, antioxidant, and inflammatory markers was observed. In conclusion, the study suggests a role for PSVE in the reduction of ESA index in HD patients with CVCs.
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The blood compatibilities of blood purification membranes and other materials developed in Japan. Int J Biomater 2011; 2011:375390. [PMID: 21969830 PMCID: PMC3182377 DOI: 10.1155/2011/375390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/25/2011] [Indexed: 11/17/2022] Open
Abstract
The biocompatibilities in blood purification therapy are defined as "a concept to stipulate safety of blood purification therapy by an index based on interaction in the body arising from blood purification therapy itself." The biocompatibilities are associated with not only materials to be used but also many factors such as sterilization method and eluted substance. It is often evaluated based on impacts on cellular pathways and on humoral pathways. Since the biocompatibilities of blood purification therapy in particular hemodialysis are not just a prognostic factor for dialysis patients but a contributory factor for long-term complications, it should be considered with adequate attention. It is important that blood purification therapy should be performed by consistently evaluating not only risks associated with these biocompatibilities but also the other advantages obtained from treatments. In this paper, the biocompatibilities of membrane and adsorption material based on Japanese original which are used for blood purification therapy are described.
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González-Diez B, Cavia M, Torres G, Abaigar P, Camarero V, Muñiz P. The effects of 1-year treatment with a haemodiafiltration with on-line regeneration of ultrafiltrate (HFR) dialysis on biomarkers of oxidative stress in patients with chronic renal failure. Mol Biol Rep 2011; 39:629-34. [PMID: 21603859 DOI: 10.1007/s11033-011-0780-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 04/27/2011] [Indexed: 12/01/2022]
Abstract
In the last few years haemodiafiltration with on-line regeneration of ultrafiltrate (HFR) has been shown to have a positive impact on inflammation and oxidative stress biomarkers, but its effect on antioxidant levels and on oxidative damage to biomolecules in the long-term is still unknown. This is a randomised clinical study over 12 months involving 40 patients on haemodialysis, comparing the effect of HFR (n=25) dialysis with haemodialysis with polysulfone (HD-PS, n=15) on oxidative stress. Total antioxidant capacity, enzymatic antioxidant [superoxide dismutase (SOD), catalase and glutathione peroxidase], non-enzymatic (GSH) and biomarkers of oxidative stress (TBARs, carbonyl groups and 8-OH-dG) were evaluated. The antioxidant activity decreased in the lymphocytes of patients dialysed with HFR, with a significant decrease in the enzyme SOD. In the oxidative stress biomarkers, an increase was seen in the levels of 8-OH-dG in patients on HD-PS dialysis but not in those treated with HFR. Throughout the year the changes in antioxidant levels and biomarkers of oxidative damage in patients dialysed with HFR were generally more modest and fluctuated less than those dialysed with HD-PS. Our study indicates that, in general, long-term dialysis with HFR does not modified antioxidant parameters or increases the oxidative damage to biomolecules. The HFR showed to be a biocompatible technique for long-term dialysis.
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Affiliation(s)
- B González-Diez
- Sección de Nefrología, Hospital General Yagüe, and Departamento de Biotecnología y Ciencia de los Alimentos, Universidad de Burgos, 09001, Burgos, Spain.
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Matsumura M, Sasaki H, Sekizuka K, Sano H, Ogawa K, Shimizu C, Yoshida H, Kobayashi S, Koremoto M, Aritomi M, Ueki K. Improved management of intradialytic hypotension (IDH) using vitamin E-bonded polysulfone membrane dialyzer. Int J Artif Organs 2010; 33:147-53. [PMID: 20383856 DOI: 10.1177/039139881003300303] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intradialytic hypotension (IDH) is a common clinical trait in hemodialysis (HD) which is caused by poor biocompatibility of the dialyzer membrane. Aiming to improve IDH, vitamin E-bonded polysulfone dialyzer (VPS-H) was evaluated in a pilot study. METHODS Eight IDH patients on standard HD were switched from their conventional high-flux dialyzers to VPS-H, and intradialytic blood pressure (BP) was monitored regularly for 10 months. RESULTS The results showed that hypotension of systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP) during the session were improved after changing the dialyzer. Notably, almost all the values recorded from 120 minutes into the session until the end of the treatment in the period between the second and tenth month after treatment were significantly different from the corresponding baseline values. Moreover, after 8 to 10 months, the SBP prior to a dialysis session was significantly reduced compared with baseline values. On the other hand, the pulse rate showed no difference throughout the study period. CONCLUSIONS This study provides early evidence of the beneficial role that vitamin E-bonded dialyzers may have in preventing IDH. Larger controlled trials are needed to confirm this original finding.
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Affiliation(s)
- Masaki Matsumura
- Medical Engineering Department, Toho-Hospital, Midori-shi, Gunma, Japan
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Takouli L, Hadjiyannakos D, Metaxaki P, Sideris V, Filiopoulos V, Anogiati A, Vlassopoulos D. Vitamin E-coated cellulose acetate dialysis membrane: long-term effect on inflammation and oxidative stress. Ren Fail 2010; 32:287-93. [DOI: 10.3109/08860221003615795] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Goto S, Fujii H, Hamada Y, Yoshiya K, Fukagawa M. Association Between Indoxyl Sulfate and Skeletal Resistance in Hemodialysis Patients. Ther Apher Dial 2010; 14:417-23. [DOI: 10.1111/j.1744-9987.2010.00813.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
New, reliable circulating oxidative stress markers have become available in chronic kidney disease (CKD) patients and have confirmed the long held belief that CKD is a pro-oxidant state. However, several questions related to this state of oxidative stress remain largely unresolved. First, the relative importance of each type of oxidant involved has been insufficiently evaluated. Only two recent studies have addressed this issue, and both suggested that chlorinated stress played a central role. Second, as only few population-based studies are available, the prevalence of oxidative stress among CKD patients remains undetermined. Third, although the link between oxidative stress and inflammation in CKD is emerging as a key process contributing to the genesis of oxidative stress in these patients, its pathogenesis remains poorly defined. Fourth, data favoring the involvement of oxidative stress in uremic toxicity are still limited. Finally, while two recent pilot studies have demonstrated that treatment of CKD patients with antioxidants is able to reduce cardiovascular events, information related to the pharmacokinetic characteristics of antioxidants, as well as their efficacy to prevent oxidative stress, is still limited in this patient group. Thus, although existing data suggest a prominent role of CKD-associated oxidative stress in uremic toxicity, further studies are required to definitively prove this concept.
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Kirmizis D, Chatzidimitriou D. Antiatherogenic effects of vitamin E: the search for the Holy Grail. Vasc Health Risk Manag 2009; 5:767-74. [PMID: 19774218 PMCID: PMC2747395 DOI: 10.2147/vhrm.s5532] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Vitamin E, a naturally occurring antioxidant, has been found to reduce atherosclerotic lesion formation in animal models as well as cardiovascular morbidity in several observational studies. However, a number of case-control and prospective cohort studies failed to confirm its value in the primary and secondary prevention of morbidity and mortality from coronary artery disease. Several small or larger randomized interventional trials completed to date failed to resolve the conflict. Notably, even in large, well-conducted prospective epidemiologic studies, the potential effects of residual confounding may be on the same order of magnitude as the reported benefit. The response to vitamin E supplementation in specific patient subpopulations with chronic inflammation and/or higher degrees of oxidative stress has not been studied as yet. Therefore, further large randomized interventional trials are warranted to clarify accurately the role of vitamin E in the primary and secondary prevention of atherosclerotic coronary disease in these patient groups.
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Odetti P, Traverso N, Monacelli F, Menini S, Vazzana J, Tasso B, Pronzato MA, Robaudo C, Deferrari G. Vitamin E-coated filter decreases levels of free 4-hydroxyl-2-nonenal during haemodialysis sessions. Free Radic Res 2009; 40:207-12. [PMID: 16390830 DOI: 10.1080/10715760500445121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Uraemic subjects undergoing chronic haemodialysis show increased oxidative stress. The use of non-biocompatible filters and reduced antioxidative defences are important sources of reactive oxygen species (ROS) release. The highly oxidative environment accelerates the onset and progression of tissue damage and atherosclerotic cardiovascular disease. The aldehyde 4-hydroxyl-2-nonenal (HNE) is probably the best marker of oxidative stress. In this study, the concentration of plasma HNE was evaluated in eight uremic subjects during two sessions of haemodialysis: the first using a standard biocompatible filter and the second using a filter coated with vitamin E. Baseline plasma levels of HNE were elevated, and dropped during haemodialysis. At the end of the session, however, low levels were maintained only when the vitamin E-modified filter was used. By contrast, a marked increase in HNE was recorded at the end of the session in all subjects who underwent haemodialysis with the conventional filter. This study provides evidence that the vitamin E-coated filter plays a role in counteracting oxidative stress. The chronic use of vitamin E-modified filters in haemodialysed subjects might help to counterbalance oxidative attack and, consequently, contribute to preventing cardiovascular disease.
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Affiliation(s)
- Patrizio Odetti
- University of Genoa, Department of Internal Medicine and Medical Specialities, Genova, Italy.
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29
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Unver S, Ipcioglu OM, Kinalp C, Ozcan O, Atasoyu EM, Evrenkaya TR. Oxidative Stress Potentials of Different Synthetic Hemodialysis Membranes. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/dat.20257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aslam S, Santha T, Leone A, Wilcox C. Effects of amlodipine and valsartan on oxidative stress and plasma methylarginines in end-stage renal disease patients on hemodialysis. Kidney Int 2006; 70:2109-15. [PMID: 17063175 DOI: 10.1038/sj.ki.5001983] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment have a markedly shortened life expectancy in large part owing to cardiovascular disease (CVD), not explained by established risk factors. We tested the hypothesis that therapy with valsartan, an angiotensin receptor blocker and amlodipine, an antioxidant calcium channel blocker will reduce oxidative stress and the plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase. We confirmed that compared with age- and gender-matched healthy controls, ESRD patients have excessive oxidative stress and arginine methylation as indexed by elevated plasma levels of oxidation products of lipids (13-hydroxyoctadecadienoic acid (13-HODE)), thiols (oxidized:reduced glutathione, oxidized glutathione (GSSG):GSH), proteins, and nucleic acids, and the methylation products ADMA and symmetric dimethylarginine (SDMA). We undertook a double blind, crossover study of equi-antihypertensive treatment with amlodipine and valsartan for 6 weeks each to test our hypothesis. Both treatments significantly reduced GSSG:GSH, 8-hydroxy 2-deoxyguanosine, ADMA, and SDMA levels and amlodipine reduced 13-HODE. We conclude that hypertensive patients with ESRD receiving HD have evidence of extensive oxidation of lipids, thiols, proteins, and nucleic acids and methylation of arginine that could contribute to CVD. Many of these changes can be reduced by short-term treatment with amlodipine and valsartan.
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Affiliation(s)
- S Aslam
- Department of Internal Medicine, Division of Nephrology and Hypertension, Georgetown University Hospital, Washington, District of Columbia 20007, USA.
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Abstract
Administration of vitamin E in children with immunoglobulin A (IgA) nephropathy, focal segmental glomerulosclerosis (FSGS) and type I diabetes demonstrated potential towards ameliorating progression. Oral vitamin E therapy reduced endothelial dysfunction, lipid peroxidation and oxidative stress in patients with chronic kidney failure (CKF). Moreover, the use of vitamin E-bonded hemodialyzers reduced atherosclerotic changes, erythropoietin dosage and muscular cramps in patients on hemodialysis (HD). However, several controlled clinical trials failed to document beneficial effects on the study subjects' cardiovascular and renal outcomes. A recent report of increased all-cause mortality in adult patients receiving high dose vitamin E therapy has caused considerable concern and debate. These issues regarding the efficacy and safety of vitamin E in renal therapeutic regimens will be reviewed in this article.
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Sosa MA, Balk EM, Lau J, Liangos O, Balakrishnan VS, Madias NE, Pereira BJG, Jaber BL. A systematic review of the effect of the Excebrane dialyser on biomarkers of lipid peroxidation. Nephrol Dial Transplant 2006; 21:2825-33. [PMID: 16861726 DOI: 10.1093/ndt/gfl376] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of cardiovascular disease and anaemia. We conducted a systematic review and meta-analysis to examine the effect of Excebrane, a vitamin E-coated cellulose-based dialyser, on circulating biomarkers of lipid peroxidation, as surrogate markers of oxidative stress. METHODS The primary sources used to identify candidate studies included PubMed, the Cochrane Central Register of Controlled Trials, a bibliography provided by the dialyser manufacturer, and a manual search of abstracts from proceedings of scientific meetings and review articles. Studies were selected for analysis if their design included a comparator group (primarily within patient comparison, i.e. pre- and post-study evaluations). For the meta-analysis, we computed the overall change of the outcome from baseline using a random-effects model. A supplemental analysis was performed in which the absolute levels of these biomarkers of lipid peroxidation were converted to a common unit by calculating standardized effect sizes. RESULTS Fourteen peer-reviewed articles met the criteria. The studies consisted of 11 single arm, one randomized crossover and two randomized controlled trials, with a total of 37 to 158 evaluable patients, according to the outcome of interest analysed. Due to the paucity of randomized trials, the meta-analysis was limited to the Excebrane arm of each study. When the studies were combined according to similar measurement units, the overall mean decrease in malondialdehyde (MDA) level was -0.3 mM (95% CI, -0.5 to -0.1 mM; seven studies) and -0.8 nmol/mg low-density lipoprotein (LDL) (95% CI, -1.3 to -0.4 nmol/mg LDL; three studies), respectively. The summary estimate revealed a non-significant decrease in pre-dialysis thiobarbituric acid reactive substances (TBARS) level of 0.4 microM (95% CI, -1.2 to 0.4 microM; three studies). When the MDA and TBARS studies were combined using the standardized effect size, the mean decrease in these biomarkers of lipid peroxidation was statistically significant at -1.7 units (95% CI, -2.7, -0.7 units; 13 studies). A meta-analysis on the effect of Excebrane on pre-dialysis levels of oxidized-LDL could not be performed due to study heterogeneity. CONCLUSION The conversion of dialysis patients to a vitamin E-coated dialyser is associated with an improvement in circulating biomarkers of lipid peroxidation, which is of potential clinical benefit.
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Affiliation(s)
- Marie Anne Sosa
- Department of Medicine, Tufts University School of Medicine, Boston, MA 02135, USA
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Sasaki M. Development of vitamin E-modified polysulfone membrane dialyzers. J Artif Organs 2006; 9:50-60. [PMID: 16614802 DOI: 10.1007/s10047-005-0318-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 09/27/2005] [Indexed: 11/30/2022]
Abstract
Oxygen radicals have recently been attracting close attention because of their involvement in tissue damage and their close relationship to various clinical conditions. It has been suggested that hemodialysis increases oxidative stress, triggering the development of complications such as atherosclerosis and dialysis-related amyloidosis. We recently developed a dialyzer containing a highly functional polysulfone membrane on which vitamin E had been bonded (PS-ViE). The present study was undertaken to evaluate the biocompatibility of this membrane and to conduct other experiments on the membrane in vitro. Human blood was dialyzed with minidialyzers (300-600 cm(2) membrane area) made of PS-ViE, cellulose, or untreated polusulfone (PS), and the effects of the dialyzers on complements (C3a, C4a, and C5a), cytokines (IL-1beta and IL-8), and granulocyte elastase as well as their anti-oxidative activity were investigated (n = 6). The effect of PS-ViE on complement activation and its effects on cytokines were comparable to those of PS membrane, whereas granulocyte elastase following dialysis with the PS-ViE membrane tended to be lower than that seen with PS membrane. The effects of PS-ViE-induced methemoglobin, lipid peroxide, and oxygen radicals were significantly less than those of PS membrane, indicating the antioxidative activity of PS-ViE. Vitamin E-modified polysulfone membrane dialyzers were found to have favorable effects on the immune system and to express antithrombotic and antioxidative effects.
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Affiliation(s)
- Masatomi Sasaki
- Development and Scientific Affairs Division, Asahi Kasei Medical Co., Ltd., MD Kanda Bldg., 9-1 Kanda Mitoshiro-cho, Chiyoda-ku, Tokyo, 101-8482, Japan.
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Gidron Y, Russ K, Tissarchondou H, Warner J. The relation between psychological factors and DNA-damage: a critical review. Biol Psychol 2006; 72:291-304. [PMID: 16406268 DOI: 10.1016/j.biopsycho.2005.11.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 11/28/2005] [Accepted: 11/29/2005] [Indexed: 11/23/2022]
Abstract
Investigating relations between psychological factors and DNA-damage can contribute to understanding how psychological factors affect the etiology and prognosis of relevant diseases (e.g., cancer, heart disease) at the fundamental level of mutated cells. This article critically reviews 21 studies in animals and humans testing relations between psychological factors and DNA-damage. After providing a biological background, we critically review each study. The findings in humans are mapped onto a model of stress, coping and health. These studies demonstrate causal relations between acute stressors and DNA-damage in animals and significant correlations between psychological factors (e.g., depression, coping) and DNA-damage in humans, which are moderated by gender. Possible mechanisms for these relations, limitations of studies, clinical implications and suggestions for future research are provided.
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Diepeveen SHA, Verhoeven GHWE, van der Palen J, Dikkeschei BLD, van Tits BLJ, Kolsters G, Offerman JJG, Bilo HJG, Stalenhoef AFH. The effect of the initiation of renal replacement therapy on lipid profile and oxidative stress during the first 6 months of treatment. Clin Chim Acta 2005; 361:112-8. [PMID: 16122722 DOI: 10.1016/j.cccn.2005.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2004] [Revised: 05/04/2005] [Accepted: 05/04/2005] [Indexed: 12/17/2022]
Abstract
BACKGROUND Disturbed lipoproteins and increased oxidative stress are two of the "non-traditional" cardiovascular risk factors in chronic renal failure. There are very few prospective data of the influence of dialysis on these two factors. In the present study we investigated the effects of the initiation of both hemo- and peritoneal dialysis therapy on lipoproteins and parameters of LDL oxidation. METHODS In this prospective cohort study, we assessed lipoproteins, plasma lipid peroxides and in vitro copper-induced LDL oxidation in 46 patients with end-stage renal disease prior to the start of dialysis and after 6 months of treatment with either hemodialysis (n=33) or peritoneal dialysis (n=13). RESULTS After 6 months of treatment with hemodialysis there was an increase in total cholesterol (4.6+/-1.1 vs. 5.0+/-1.3 mmol/l; p<0.05) and triglycerides (2.0+/-0.9 vs. 2.8+/-1.6 mmol/l; p<0.03). In the peritoneal dialysis group the lipoproteins did not change. Regarding lipid peroxides and in vitro copper-induced LDL oxidation, also no changes were observed after 6 months of treatment in both groups. CONCLUSION Dyslipidemia aggravates after 6 months of hemodialysis but not after 6 months of peritoneal dialysis. During this period, no net effects on oxidative stress were demonstrated.
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Affiliation(s)
- Sabine H A Diepeveen
- Department of Internal Medicine, Isala Clinics, location Weezenlanden, Zwolle, The Netherlands.
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Włodek PJ, Smolenski OB, Chwatko G, Iciek MB, Miłkowski A, Bald E, Włodek L. Disruption of thiol homeostasis in plasma of terminal renal failure patients. Clin Chim Acta 2005; 366:137-45. [PMID: 16337615 DOI: 10.1016/j.cca.2005.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 09/12/2005] [Accepted: 09/12/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of the present studies was to investigate the changes in concentrations of different forms of thiols in plasma of terminal renal failure patients before and after hemodialysis. METHODS Total concentrations of thiols, their free forms and the level of their mixed disulfides with proteins were determined with HPLC. RESULTS In terminal renal failure patients before dialysis, total concentrations of cysteine, homocysteine and cysteinylglycine and their free and protein-bound fractions increased while level of all such forms of glutathione dropped. A single dialysis session caused short-lasting return of concentrations of all forms of thiols to the level equal or close to the control group. The changes observed in non-dialyzed patients were similar to those observed in dialyzed patients before single dialysis procedure. CONCLUSIONS The obtained results showed severe disturbance of thiol homeostasis in plasma of terminal renal failure patients. The following changes have to be emphasized: (1) high level of free cysteine (cystine) fraction, (2) strong tendency of homocysteine to form mixed disulfides with proteins, (3) drop of glutathione level. These observations confirm a suggestion that atherogenic action of homocysteine can be a result of S-homocysteinylation and N-homocysteinylation reactions, whereas toxic action of cysteine can result from auto-oxidation reaction.
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Affiliation(s)
- Przemysław J Włodek
- Department of Nephrology, Rydygier Hospital, os. Złotej Jesieni 1, 31-826 Cracow, Poland
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Morimoto H, Nakao K, Fukuoka K, Sarai A, Yano A, Kihara T, Fukuda S, Wada J, Makino H. Long-term use of vitamin E-coated polysulfone membrane reduces oxidative stress markers in haemodialysis patients. Nephrol Dial Transplant 2005; 20:2775-82. [PMID: 16221689 DOI: 10.1093/ndt/gfi121] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and an independent predictor of overall mortality and cardiovascular outcome in haemodialysis (HD) patients. In the present study, we compared the effects of a vitamin E-coated polysulfone membrane (PSE) and a non-vitamin E-coated polysulfone membrane (PS) on oxidative stress markers such as ADMA. METHODS Thirty-one HD patients were enrolled to this investigation. They were allocated into two groups: in the PSE group (n = 16), PSE was used for 6 months, followed by PS for an additional 12 months; in the PS group (n = 15), PS was used for the entire observation period. Plasma ADMA, oxidized low density lipoprotein (Ox-LDL) and malondialdehyde LDL (MDA-LDL) levels were measured at baseline, 3, 6, 12 and 18 months. Plasma ADMA in peritoneal dialysis (PD) patients and in healthy individuals was also measured. RESULTS Predialysis concentrations of ADMA (0.72+/- 0.13 nmol/ml) were significantly higher in the HD group than in both PD patients (0.63+/-0.10 nmol/ml, P<0.01) and healthy individuals (0.44+/-0.01 nmol/ml, P<0.0001). Treatment with PSE for 6 months significantly reduced predialysis levels of ADMA (0.54+/-0.09 nmol/ml) compared with baseline (0.74+/-0.12 nmol/ml; P<0.01). Predialysis levels of Ox-LDL and MDA-LDL after 6 months therapy with PSE were also significantly lower than baseline values. Treatment with PS subsequent to treatment with PSE again increased ADMA, Ox-LDL and MDA-LDL back to baseline levels. In the PS group, ADMA, Ox-LDL and MDA-LDL levels remained unchanged during the entire treatment period of 18 months. CONCLUSIONS We confirmed that use of PSE reduced ADMA that had accumulated in HD patients. This finding indicates that PSE exerts anti-oxidant activity. A randomized controlled study will be required to determine whether PSE prevents cardiovascular diseases and other dialysis-related complications by reducing oxidative stress.
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Affiliation(s)
- Hisanori Morimoto
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
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Lucchi L, Iannone A, Bergamini S, Stipo L, Perrone S, Uggeri S, Gatti V, Ferrari F, Tomasi A, Albertazzi A. Comparison Between Hydroperoxides and Malondialdehyde as Markers of Acute Oxidative Injury During Hemodialysis. Artif Organs 2005; 29:832-7. [PMID: 16185346 DOI: 10.1111/j.1525-1594.2005.00136.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An increased free-radical production has been documented during hemodialysis (HD) particularly when bio-incompatible membranes are utilized. These highly reactive free radicals can cause damage through several pathways, one of the best known being lipid peroxidation. Malondialdehyde (MDA) is a product of lipid peroxidation, which can partly be removed by HD due to its low molecular weight and water solubility. Hydroperoxides are predominantly found in lipid substances, and therefore their removal by HD could be difficult. We evaluated the behavior of these two by-products of lipid peroxidation during HD, comparing their behavior in three different membranes, in order to study their reliability as markers of acute oxidative injury. Fifteen stable HD patients were dialyzed with each of the following membranes: cuprophan, polyamide, and polysulfone, three sessions for every membrane. MDA and hydroperoxides were measured pre-HD and then both from the arterial and venous line at 8, 15, 30, and 240 min. During HD with cuprophan membrane MDA decreased significantly in the venous line compared with the arterial line at 8, 15, and 30 min (P < 0.05). At the end of HD, MDA was significantly reduced compared with MDA pre-HD (P < 0.05). Plasma hydroperoxides increased significantly in the venous line compared with the arterial line at 8, 15, 30, and 240 min (P < 0.05). At the end of HD, hydroperoxides had increased significantly as compared with pre-HD (P < 0.05). When the polyamide and polysulfone membranes were used, the behavior of MDA was similar to that found with cuprophan. Hydroperoxides were unchanged during HD using both membranes. MDA is not a reliable marker of acute oxidative injury during HD as it is removed during HD. Hydroperoxide measurement is a better marker of acute oxidative injury during HD.
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Yoshimura K, Nakano H, Yokoyama K, Nakayama M. High iron storage levels are associated with increased DNA oxidative injury in patients on regular hemodialysis. Clin Exp Nephrol 2005; 9:158-63. [PMID: 15980952 DOI: 10.1007/s10157-005-0354-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 03/11/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Accumulating evidence suggests that oxidative stress is enhanced in patients on regular hemodialysis (HD). Iron supplementation is essential for the treatment of renal anemia, but there is a possibility that it could enhance oxidative stress by inducing the Fenton reaction. Here, we report our investigation of the relation between iron storage and DNA oxidative injury in HD patients. METHODS The study subjects were 48 patients on regular HD (age, 62.7 +/- 12.1 years; HD duration, 67.2 +/- 62.5 months; non-diabetic/diabetic; 22:26). Patients who were positive for hepatitis C virus antibody (HCV Ab), or hepatitis B surface antigen (HBsAg), and those with inflammatory or malignant diseases were excluded. The serum 8-hydroxy-2'-deoxyguanosine (8-OHdG) level, a marker of DNA oxidative injury, was measured before the first HD session of the week in all patients, and factors associated with high serum 8-OHdG were investigated. In 9 patients with a serum ferritin level of more than 1000 ng/ml at study entry, serum 8-OHdG levels were followed up for 6 months in the absence of iron supplementation. RESULTS Multivariate analysis showed that the serum ferritin level was a significant and independent determinant of serum 8-OHdG, and serum ferritin correlated significantly with the total dose of iron supplementation during the 6-month period of the study. In the nine patients, without iron supplementation, serum 8-OHdG levels, as well as serum ferritin, decreased significantly during follow-up. CONCLUSIONS Our results suggest that increased iron storage may induce DNA oxidative injury in patients on regular HD, and that the serum ferritin level is a surrogate marker for this pathological condition.
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Affiliation(s)
- Kazunobu Yoshimura
- Department of Kidney and Hypertension, Tokyo Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Steghens JP, Combarnous F, Arkouche W, Flourie F, Hadj-Aissa A. Influence de l'hémodialyse sur les concentrations de malonedialdéhyde total et libre, mesurées par une nouvelle technique HPLC spécifique. Nephrol Ther 2005; 1:121-5. [PMID: 16895675 DOI: 10.1016/j.nephro.2004.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Accepted: 04/13/2004] [Indexed: 01/04/2023]
Abstract
Accurate evaluation of oxidative stress is needed for patients on chronic hemodialysis (HD), as cardiovascular risk level seems related to it. Oxidative stress is often evaluated by measuring an end product of lipoperoxidation named malondialdehyde (MDA). However, the most common technique for measuring MDA, the Thio Barbituric Acid Reactive Substances method (TBARS), is known to be sensitive but poorly specific. We measured true total and free plasma MDA in fifty-four unselected patients on long-term HD, before and after HD sessions, by a new, highly specific HPLC method. Total and free MDA were higher before than after dialysis. Essentially, free MDA was decreased by HD but its fractional decrease was lower than that of urea or creatinine. This confirms that, in fact, free MDA is more or less bound to low molecular weight compounds and/or suggests that MDA may be produced mainly during HD sessions. We propose this new tool to further explore the relationship between oxidative stress, HD and true MDA.
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Affiliation(s)
- Jean-Paul Steghens
- Fédération de Biochimie, Hôpital Edouard-Herriot, EA 3090, UCBL1, Place d'Arsonval, 69347 Lyon Cedex 03, France.
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Shoji T, Nishizawa Y. Chronic kidney disease as a metabolic syndrome with malnutrition--need for strict control of risk factors. Intern Med 2005; 44:179-87. [PMID: 15805704 DOI: 10.2169/internalmedicine.44.179] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk for death from cardiovascular disease (CVD). They have multiple metabolic abnormalities that may accelerate atherosclerosis, such as hypertension, insulin resistance, and dyslipidemia, along with other CKD-related risk factors. In addition, a considerable proportion of patients with advanced stages of CKD are malnourished, presenting "metabolic syndrome with malnutrition". The presence of malnutrition/inflammation dramatically changes the apparent relationship between CVD death risk and some risk factors. For example, in stage 5 CKD patients on hemodialysis, a higher body mass index and a higher plasma cholesterol are predictors of better survival. To understand the paradoxic epidemiology, we should recognize risk factors for occurrence of CVD events and risk factors of fatality after an event. In this article, we review the unique situation of CKD, emphasizing the need of more strict control of both types of risk factors to improve survival of CKD patients.
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Affiliation(s)
- Tetsuo Shoji
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545-8585
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Abstract
Hemodialysis membranes have undergone a gradual but substantial evolution over the past few decades. Classification of modern dialyzer membranes by chemical composition bears little relationship to their functional characteristics. The fundamental properties that determine the capacity of the membrane to remove solutes and fluids are its surface area, thickness, pore size, pore density, and potential to adsorb proteins. Dialyzer membrane performance is characterized clinically by its efficiency, defined as the potential to remove urea and presented as the mass-transfer area coefficient (KoA) and ultrafiltration coefficient (K(uf) ),defined as the potential to remove water adjusted for the transmembrane pressure. The parameter K(uf) usually, but not invariably, correlates with the membrane permeability, defined as the potential to remove middle molecules, with beta2-microglobulin being the currently popular marker. The sieving coefficient reflects the membrane potential to transport solutes by convection and is particularly useful for hemofiltration. Enhancing solute clearance is accomplished clinically by increasing blood and dialysate flow rates, strategies that also are applicable to middle molecules for highly permeable membranes. Novel designs of dialyzers include the optimization of fluid flow path geometry and increasing the membrane pore selectivity for solutes by using nanotechnology.
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Affiliation(s)
- Madhukar Chelamcharla
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
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Tomo T, Matsuyama K, Nasu M. Effect of Hemodiafiltration against Radical Stress in the Course of Blood Purification. Blood Purif 2005; 22 Suppl 2:72-7. [PMID: 15655328 DOI: 10.1159/000081879] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The involvement of radical stress has been suggested as a cause for complications in patients on dialysis, such as arteriosclerosis, dialysis-related amyloidosis, etc. It has been reported that the increase in radical stress is not only seen in renal failure, but that its amplified effect is also seen in the process of blood purification. Our group has reported on the radical stress-reducing effect of HDF. We performed four types of blood purification (HD; on-line HDF; pre, on-line HDF; post, P/P HDF) in patients on maintenance dialysis using the polysulfone (APS) dialyzer. The change in radical related markers such as pentosidine (total, free) and CML (total, free), and the CTL/Cr ratio, and the hydroperoxide radicals were studied. In HDF (post, pre), the amplification rate of hydroperoxide radicals was significantly low, whereas the reduction rate of CTL/Cr ratio as index for hydroxy radicals was significantly higher in on-line HDF than in HD. Both the total CML and T-pentosidine increased in HD but showed a decrease in HDF. As HDF uses large amounts of replacement solution, the following effects can be expected: (a) suppression of the amplification of hydroperoxide radicals and suppression of the amplification of hydroxy radicals, and (b) suppression of fat oxidation by AGEs themselves. These antiradical stress effects are presumed to be exerted by effective removal of radical carrier protein, denatured protein, and complement protein in HDF, by dilution of radicals by massive use of replacement solution, and by the sequential reduction of the excitation and amplification effects.
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Affiliation(s)
- Tadashi Tomo
- Second Department of Internal Medicine, Oita University, Faculty of Medicine, Hazama, Japan.
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Abstract
Because of correlations between cardiovascular disease, inflammation, and renal failure, many investigators are pursuing nontraditional risk factors and therapies in order to reduce cardiovascular morbidity and mortality in the end-stage renal disease (ESRD) population. Despite the disappointing lack of clinical effects with antioxidative therapies seen in large studies of the general population, some studies suggest a diminished cardiovascular risk in individuals with renal failure. This expanding new line of evidence is promising as a method to help alleviate the more than 20-fold increase in risk of cardiovascular events in the ESRD population. Most of the current available studies have evaluated laboratory or physiologic endpoints, such as endothelial function and measures of oxidative burden, and have evaluated relatively small numbers of patients. However, it is currently premature to initiate widespread clinical therapy with antioxidants. Further investigation in this area should be supported to see if reported benefits can be duplicated in more widespread study populations, and to more accurately define the most appropriate choice of therapy, mode of therapy, and dose.
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Zhang X, Frischmann M, Kientsch-Engel R, Steinmann K, Stopper H, Niwa T, Pischetsrieder M. Two immunochemical assays to measure advanced glycation end-products in serum from dialysis patients. Clin Chem Lab Med 2005; 43:503-11. [PMID: 15899672 DOI: 10.1515/cclm.2005.089] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractAdvanced glycation end-products are uremic toxins that accumulate in the serum and tissues of patients with chronic renal failure. Here, we established two enzyme-linked immunosorbent assays (ELISAs) for N
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Affiliation(s)
- Xiaohong Zhang
- Institute of Pharmacy and Food Chemistry, University Erlangen-Nuremberg, Germany
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Mydlík M, Derzsiová K, Rácz O, Sipulová A, Lovásová E, Molcányiová A, Petrovicová J. Vitamin E-coated dialyzer and antioxidant defense parameters: Three-month study. Semin Nephrol 2004; 24:525-31. [PMID: 15490422 DOI: 10.1016/j.semnephrol.2004.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atherosclerotic cardiovascular disease is the most frequent cause of death in patients with end-stage renal disease who have undergone dialysis treatment. Oxidative stress, increased lipid peroxidation, and impaired function of antioxidant systems may contribute to the accelerated development of atherosclerosis in chronic renal failure patients during renal replacement therapy. The aim of this study was to investigate the influence of a vitamin E-coated dialyzer on antioxidant defense parameters in hemodialysis (HD) patients. In 14 HD patients, hemodialysis was performed using a vitamin E-coated dialyzer (Terumo CL-E15NL; Terumo Corporation, Tokyo, Japan) during a 3-month study. In these patients, erythrocyte (ER) antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione reductase (GR) and catalase (CAT), plasma total antioxidant capacity (TAC), RBC glutathione (GSH), plasma malondialdehyde (MDA), plasma, and RBC vitamin E were investigated. Each parameter was measured at the beginning of the study, after the 1st, 2nd, and 3rd month of the study, and 10 weeks after the interruption of the use of vitamin E-coated dialyzer. All HD patients were treated by erythropoietin (EPO) and received vitamin C 50 mg/d, pyridoxine 20 mg/d, and folic acid 5 mg/wk during the entire study. The 3-month treatment with the vitamin E-coated dialyzer led to a significant decrease of plasma MDA level (from 2.85 +/- 0.44 to 2.25 +/- 0.37 micromol/L) and to an increase of plasma TAC, RBC, GSH, and the vitamin E levels both in plasma (from 25.9 +/- 2.8 to 33.6 +/- 3.8 micromol/L) and in the RBCs (from 6.7 +/- 0.8 to 7.4 +/- 0.7 micromol/L) by 30% and 10.5%, respectively. Ten-week interruption of the use of the vitamin E-coated dialyzer led to near initial values of MDA (2.90 +/- 0.28 micromol/L), plasma (28.6 +/- 3.5 micromol/L), and RBC (6.9 +/- 0.7 micromol/L) vitamin E and of other investigated parameters. Statistical analysis of results was performed by conventional methods and analysis of variance. The findings of the current study confirm the beneficial effect of the vitamin E-coated dialyzer against oxidative stress in HD patients.
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Affiliation(s)
- Miroslav Mydlík
- Nephrological Clinic, University Hospital of L. Pasteur, Kosice, Slovak Republic
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Giray B, Kan E, Bali M, Hincal F, Basaran N. The effect of vitamin E supplementation on antioxidant enzyme activities and lipid peroxidation levels in hemodialysis patients. Clin Chim Acta 2004; 338:91-8. [PMID: 14637272 DOI: 10.1016/j.cccn.2003.07.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study has been undertaken to investigate the possible alterations of oxidant/antioxidant status in uremic patients undergoing hemodialysis (HD) and the effects of vitamin E supplementation. METHODS Erythrocyte antioxidant enzyme activities [glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and catalase (CAT)] and thiobarbituric acid reactive substance (TBARS) concentrations as a measure of lipid peroxidation in HD patients have been determined and compared with healthy controls. The patient group consisted of 36 uremic patients 21-75 years of age undergoing maintenance HD three times weekly for an average of 41 months. The efficiency of Vitamin E therapy in dialysis patients was also assessed by re-evaluating antioxidant status of the same patients after supplementation of the vitamin E in a dosage of 600 mg/daily for 14 weeks. RESULTS A significant decrease in the activities of erythrocyte SOD, CAT and GSHPx and a significant increase in TBARS concentrations were found in patient group compared to control group (p<0.001). A significant correlation between GSHPx activities and duration of HD therapy was also observed (r=-0.46, p<0.01). Vitamin E supplementation caused an increase in GSHPx and SOD activities and a decrease in TBARS concentrations. A slight but not significant increase in CAT activity was also observed by Vitamin E. CONCLUSIONS The results suggest the presence of an oxidative activity and the possible preventive role of Vitamin E therapy in uremic patients undergoing HD.
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Affiliation(s)
- Belma Giray
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara 06100, Turkey
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Gross ML, Amann K. Progression of renal disease: new insights into risk factors and pathomechanisms. Curr Opin Nephrol Hypertens 2004; 13:307-12. [PMID: 15073489 DOI: 10.1097/00041552-200405000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Progression of renal failure, irrespective of the primary cause, is characterized by modification of renal structure, which culminates in terminal renal insufficiency. Interfering with progression continues to be a major challenge and is at the forefront of renal research. This review focuses on recent progress in the understanding of the mechanisms of progression and efforts to interfere with this process. RECENT FINDINGS In addition to the long-known risk factors (hypertension and inadequate activation of the renin-angiotensin system), several novel risk factors and pathomechanisms, such as obesity, hyperglycemia, smoking, and several hormones, have recently been identified and investigated. Furthermore, the specific and blood pressure-independent pathogenetic roles of the sympathetic nervous system and the endothelin system in progression have been further clarified. Finally, novel animal models and techniques for studying specific aspects of progression have been developed and introduced. SUMMARY Recently, considerable progress has been made concerning novel risk factors, understanding the underlying pathomechanisms, and interfering with the course of progression of renal diseases. Such improved insights will undoubtedly lead to new strategies in the future.
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Libetta C, Zucchi M, Gori E, Sepe V, Galli F, Meloni F, Milanesi F, Dal Canton A. Vitamin E–loaded dialyzer resets PBMC-operated cytokine network in dialysis patients. Kidney Int 2004; 65:1473-81. [PMID: 15086491 DOI: 10.1111/j.1523-1755.2004.00528.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In hemodialysis patients the activity of stimulated Th1 lymphocytes is depressed, while Th2 cells are constitutively primed. Such phenomena may depend on monocyte activation and altered release of interleukin (IL)-12 and IL-18, which regulate Th cell differentiation. Reactive oxygen species (ROS) activate monocytes; therefore, a hemodialyzer with antioxidant activity would contrast ROS, prevent monocyte activation, reset IL-12 and IL-18 release, and restore Th1/Th2 balance. METHODS Ten patients on regular dialysis treatment (RDT) with cellulosic membrane (CM) were shifted to vitamin E-coated dialyzer (VE). During treatment with CM and after 3, 6, and 12 months of treatment with VE, peripheral blood mononuclear cells (PBMC) and purified CD4+ cells were isolated, and cultured, resting, mitogen-stimulated, and interferon gamma (IFNgamma), IL-4, IL-10, IL-12, and IL-18 release was measured. Vitamin E and A plasma levels and the effects of a single dialysis session on peripheral blood NO levels were assayed. RESULTS The constitutive release of IL-4 and IL-10 by CD4+ cells was abated significantly by treatment with VE (nadir -77.8% and -55.3%, respectively, at 12 months). INFgamma release by mitogen-stimulated CD4+ recovered with VE (zenith +501% at 12 months). PBMC constitutive production of IL-12 and IL-18 was significantly reduced by VE (nadir at 12 months -64.7% and -51.3%, respectively). VE increased plasma levels of vitamins E and A. NO plasma levels fell after a single dialysis treatment with VE (-17%, P < 0.05) in contrast with CU (+27.1%, P < 0.05). CONCLUSION The network of cytokines released by monocytes and Th cells is reset toward normality by treatment with vitamin E-coated dialyzer.
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Affiliation(s)
- Carmelo Libetta
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Policlinico San Matteo and University, Pavia, Italy.
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