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Ni C, Zhou W, Yu M, Li X, Li J, Cui Y, Cui W. Vitamin E Treatment Improves the Antioxidant Capacity of Patients Receiving Dialysis: A Systematic Review and Meta-Analysis. Mol Nutr Food Res 2023; 67:e2300269. [PMID: 37726247 DOI: 10.1002/mnfr.202300269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/10/2023] [Indexed: 09/21/2023]
Abstract
SCOPE To summarize the effect of vitamin E-coated dialyzer membranes (VEMs) treatment or oral vitamin E intake on antioxidant molecules, such as superoxide dismutase (SOD), glutathione peroxidase (GPX), catalase (CAT), and total antioxidant level in patients receiving dialysis. METHODS AND RESULTS A literature search of PubMed, Embase, CNKI, and the Cochrane Library databases is performed from inception to July 1, 2023, with no language nor country restrictions. Twenty-four experimental studies involving 512 patients undergoing dialysis are selected for meta-analysis. The levels of antioxidant markers in the blood of patients receiving hemodialysis (HD) improve with long-term VEMs treatment (p = 0.016). According to the findings of each antioxidant index, there is a significant increase in the levels of erythrocyte-derived SOD (p = 0.047), CAT (p = 0.029), and plasma-derived total antioxidant level (p < 0.001). The antioxidant marker levels in patients receiving HD are significantly increased by oral vitamin E intake (p < 0.001). Erythrocyte-derived SOD (p = 0.003), GPX (p < 0.001), and CAT (p = 0.001) substantially improves after 2-6 months of intervention with oral vitamin E preparation. The antioxidant index of patients receiving peritoneal dialysis (PD) is unaffected by oral vitamin E treatment (p = 0.945). CONCLUSION Vitamin E therapy has a favorable effect on the retention of antioxidant compounds in patients undergoing dialysis.
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Affiliation(s)
- Ce Ni
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, China
| | - Wenhua Zhou
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, China
| | - Mengyuan Yu
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, China
| | - Xinyang Li
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, China
| | - Jian Li
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, China
| | - Yingchun Cui
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, 218 Zi-Qiang Street, Changchun, Jilin, 130000, 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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Abstract
Dyslipidemia is a common feature of various renal diseases. This perturbed lipid metabolism results in accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Treatment of dyslipidemia, in addition to normalization of blood pressure and reduction of proteinuria, could provide additional means to retard the progression of chronic renal insufficiency. Possible therapeutic approaches include mainly dietary and life-style modifications, selective use of some technical components of dialysis systems, and the judicious prescriptions of lipid-lowering drugs. Even with relatively normal lipid and lipoprotein profiles statin therapy seems to prevent atherogenesis acceleration. A wide range of therapeutic interventions, targeting the lipid abnormalities that may develop in chronic renal patients and end-stage renal disease (ESRD) are currently available, though still without convincing evidence based on long-term prospective studies which clearly demonstrate a significant reduction in cardiovascular morbidity and mortality of ESRD patients. However, extensive investigations, concerning the best long-term therapeutic strategy for this high-risk population of patients, are still missing.
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Affiliation(s)
- V Stefanovic
- Institute of Nephrology and Hemodialysis, Faculty of Medicine, Nis - Serbia.
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4
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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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5
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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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Sotoudeh Anvari M, Mortazavian Babaki M, Boroumand MA, Eslami B, Jalali A, Goodarzynejad H. Relationship between calculated total antioxidant status and atherosclerotic coronary artery disease. Anatol J Cardiol 2015; 16:689-95. [PMID: 27488746 PMCID: PMC5331354 DOI: 10.5152/anatoljcardiol.2015.6482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: Antioxidants play a major role in the cellular protection cascade against oxidative damage. Oxidative stress has been linked to the pathogenesis of coronary atherosclerosis. Our aim was to evaluate the association between calculated serum total antioxidant status (cTAS) and the presence and severity of coronary artery disease (CAD). Methods: One hundred and seventy-four patients with angiographically documented significant (≥50%) luminal stenosis (n=123) or with minimal (<50%) luminal stenosis (n=51) in at least one coronary artery or major branch segment in the epicardial coronary tree were categorized as CAD+ group; 88 patients with no luminal stenosis were considered as the control group. The level of cTAS (mmol/L) was evaluated using the following equation: (0.63´albumin concentration)+(1.02´uric acid concentration)+(1.53´bilirubin concentration). Results: In univariate analyses, mean levels of cTAS, uric acid, and creatinine were significantly higher in CAD+ group than in controls. However, adjusted cTAS level was not found to be a CAD predictor in the total population [odds ratio (OR)=1.20; 95% confidence interval (CI): 0.81–1.76; p=0.364] or in men (OR=1.25; 95% CI: 0.73–2.12; p=0.420) and women (OR=1.20; 95% CI: 0.66–2.19; p=0.553). A weak but statistically significant correlation was found between cTAS and Gensini score (Spearman’s r=0.16, p=0.015). Conclusion: In patients with suspicious CAD, the level of cTAS was not found to be an independent predictor for the presence of CAD. Further studies with larger sample size are required to confirm the results.
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Affiliation(s)
- Maryam Sotoudeh Anvari
- Department of Surgical and Clinical Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-Iran
| | - Maryam Mortazavian Babaki
- Department of Surgical and Clinical Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-Iran
| | - Mohammad Ali Boroumand
- Department of Surgical and Clinical Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-Iran
| | - Bahareh Eslami
- Department of Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-Iran
| | - Arash Jalali
- Department of Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-Iran
| | - Hamidreza Goodarzynejad
- Department of Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran-Iran. ,
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Clos AL, Kayed R, Lasagna-Reeves CA. Association of skin with the pathogenesis and treatment of neurodegenerative amyloidosis. Front Neurol 2012; 3:5. [PMID: 22319507 PMCID: PMC3262151 DOI: 10.3389/fneur.2012.00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/04/2012] [Indexed: 12/12/2022] Open
Abstract
Amyloidosis are a large group of conformational diseases characterized by abnormal protein folding and assembly which results in the accumulation of insoluble protein aggregates that may accumulate systemically or locally in certain organs or tissue. In local amyloidosis, amyloid deposits are restricted to a particular organ or tissue. Alzheimer’s, Parkinson’s disease, and amyotrophic lateral sclerosis are some examples of neurodegenerative amyloidosis. Local manifestation of protein aggregation in the skin has also been reported. Brain and skin are highly connected at a physiological and pathological level. Recently several studies demonstrated a strong connection between brain and skin in different amyloid diseases. In the present review, we discuss the relevance of the “brain–skin connection” in different neurodegenerative amyloidosis, not only at the pathological level, but also as a strategy for the treatment of these diseases.
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Affiliation(s)
- Audra L Clos
- Department of Dermatology, MD Anderson Cancer Center, University of Texas Houston, TX, USA
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8
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Kalousová M, Kuběna AA, Koštířová M, Vinglerová M, Ing OM, Dusilová-Sulková S, Tesař V, Zima T. Lower Retinol Levels as an Independent Predictor of Mortality in Long-term Hemodialysis Patients: A Prospective Observational Cohort Study. Am J Kidney Dis 2010; 56:513-21. [DOI: 10.1053/j.ajkd.2010.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 03/25/2010] [Indexed: 12/13/2022]
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9
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Bavbek N, Akay H, Uz B, Uz E, Turgut F, Kanbay M, Senes M, Akcay A, Duranay M. The Effects of L-Carnitine Therapy on Respiratory Function Tests in Chronic Hemodialysis Patients. Ren Fail 2010; 32:157-61. [DOI: 10.3109/08860221003592812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Galli F. On the antiatherogenic effects of vitamin E: the search for the Holy Grail. Vasc Health Risk Manag 2010; 6:69-71; author reply 71. [PMID: 20234781 PMCID: PMC2835556 DOI: 10.2147/vhrm.s9289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Indexed: 01/12/2023] Open
Affiliation(s)
- Francesco Galli
- Correspondence: Francesco Galli, Department of Internal Medicine, Laboratory of Clinical Biochemistry and Nutrition, University of Perugia, Italy, Tel +39 075 585 7445, Fax +39 075 585 7445, Email
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11
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Iughetti L, Perugini C, Predieri B, Madeo S, Bellomo G, Bernasconi S, Balli F. Low-density lipoprotein oxidizability in children with chronic renal failure. Pediatr Int 2008; 50:447-53. [PMID: 19143965 DOI: 10.1111/j.1442-200x.2008.02614.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In childhood, dyslipidemia and low-density lipoprotein (LDL) oxidation play an important role in the development of atherosclerosis. Alterations of these factors have been shown in adult uremic patients. METHODS Nine children affected by chronic renal failure (CRF; urinary tract malformation, n = 8; polycystic kidney disease, n = 1) were studied to investigate the abnormalities of plasma lipoprotein concentration and composition and to assess the susceptibility of LDL to oxidation. All patients with CRF were on conservative treatment and, after informed consent, underwent the evaluation of (i) quantitative and qualitative plasma lipid profile; (ii) lipoprotein oxidation in vitro; and (iii) lipoprotein anti-oxidant content. These results were compared to those of an age-matched control group of eight healthy children. RESULTS Total cholesterol, LDL and triglycerides were significantly higher in CRF than in the control group. The composition of lipoproteins was different in the two groups: the amount of anti-oxidant factors (alpha-, gamma-tocopherol and carotenoids) was different in CRF and normal controls children, while LDL susceptibility to oxidation was significantly higher in uremic children than in controls. CONCLUSIONS CRF patients, already before dialysis, have a higher LDL oxidizability due to an altered lipoprotein composition and a low anti-oxidant content; therefore they have higher risk factors for atherosclerosis. On the basis of these data, supplementation with anti-oxidants might be useful in CRF children, but further studies are needed to evaluate the efficacy and safety of this therapeutic intervention.
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Affiliation(s)
- Lorenzo Iughetti
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
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12
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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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15
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Abstract
This study was designed to test the removal of beta2-microglobulin (beta2M) in a vitamin E-modified membrane. We investigated in vivo the dialyzer (Excebrane, series EE, 1.8 m2) with respect to hydraulic permeability (Kuf), maximum ultrafiltration rate (UF max), sieving coefficient (Sc), and solute clearances in hemodialysis (HD) and in soft hemodiafiltration (HDF). Kuf was 18.4 ml/h/mmHg, UF max was 75 ml/min, and Sc for beta2M was 0.45. Clearance values at 400 ml/min of Qb in HD were 258 ml/min for urea, 201 ml/min for creatinine, and 135 ml/min for phosphate. In soft HDF, clearances were slightly higher. beta2M clearance was 26 ml/min in HD and 43 ml/min in soft HDF. In conclusion, Excebrane (series EE) procures a soft HDF with an amount of substitution fluid in post dilution mode of over 60 ml/min. Remarkable small solute clearances were obtained when the blood flow was raised to 400 ml/min. A significant reduction of beta2M is demonstrated by HDF.
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Affiliation(s)
- S Mandolfo
- Renal Unit, Ospedale Maggiore, Lodi, Italy.
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16
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Malliaraki N, Mpliamplias D, Kampa M, Perakis K, Margioris AN, Castanas E. Total and corrected antioxidant capacity in hemodialyzed patients. BMC Nephrol 2003; 4:4. [PMID: 12837136 PMCID: PMC166281 DOI: 10.1186/1471-2369-4-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2003] [Accepted: 07/01/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oxidative stress may play a critical role in the vascular disease of end stage renal failure and hemodialysis patients. Studies, analyzing either discrete analytes and antioxidant substances, or the integrated total antioxidant activity of human plasma during hemodialysis, give contradictory results. METHODS Recently, we have introduced a new automated method for the determination of Total Antioxidant Capacity (TAC) of human plasma. We have serially measured TAC and corrected TAC (cTAC: after subtraction of the interactions due to endogenous uric acid, bilirubin and albumin) in 10 patients before the onset of the dialysis session, 10 min, 30 min, 1 h, 2 h and 3 h into the procedure and after completion of the session. RESULTS Our results indicate that TAC decreases, reaching minimum levels at 2 h. However, corrected TAC increases with t1/2 of about 30 min. We then repeated the measurements in 65 patients undergoing dialysis with different filters (36 patients with ethylene vinyl alcohol copolymer resin filter -Eval-, 23 patients with two polysulfone filters -10 with F6 and 13 with PSN140-, and 6 patients with hemophan filters). Three specimens were collected (0, 30, 240 min). The results of this second group confirm our initial results, while no significant difference was observed using either filter. CONCLUSIONS Our results are discussed under the point of view of possible mechanisms of modification of endogenous antioxidants, and the interaction of lipid- and water-soluble antioxidants.
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Affiliation(s)
- Niki Malliaraki
- Departments of Clinical Chemistry, University of Crete, School of Medicine, and University Hospital, Heraklion, GR-71110, Greece
| | - Dimitris Mpliamplias
- Experimental Endocrinology, University of Crete, School of Medicine, and University Hospital, Heraklion, GR-71110, Greece
| | - Marilena Kampa
- Experimental Endocrinology, University of Crete, School of Medicine, and University Hospital, Heraklion, GR-71110, Greece
| | - Kostas Perakis
- Nephrology, University of Crete, School of Medicine, and University Hospital, Heraklion, GR-71110, Greece
| | - Andrew N Margioris
- Departments of Clinical Chemistry, University of Crete, School of Medicine, and University Hospital, Heraklion, GR-71110, Greece
| | - Elias Castanas
- Experimental Endocrinology, University of Crete, School of Medicine, and University Hospital, Heraklion, GR-71110, Greece
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Pawlak K, Borawski J, Naumnik B, Mysliwiec M. Relationship between oxidative stress and extrinsic coagulation pathway in haemodialyzed patients. Thromb Res 2003; 109:247-51. [PMID: 12818246 DOI: 10.1016/s0049-3848(03)00241-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Enhanced oxidative stress (SOX), endothelial dysfunction and haemostatic abnormalities are common in end-stage renal failure patients undergoing maintenance haemodialysis (HD). We studied associations among circulating immunoreactive total lipid peroxides as a marker of short-time SOX, autoantibodies against oxidized LDL as a surrogate of prolonged SOX, copper/zinc superoxide dismutase (Cu/Zn SOD) as a major antioxidant enzyme, tissue factor (TF) as a principal initiator of extrinsic coagulation pathway counteracted by its inhibitor (TFPI), and prothrombin fragment 1+2 (F 1+2) as a surrogate of activated haemostasis.Pre-dialysis blood levels of all the markers studied were higher in 24 clinically stable HD patients compared to 11 healthy controls. Spearman's correlations among the three SOX markers were positive but nonsignificant in both HD patients and controls. In HD subjects, increased Cu/Zn SOD levels directly correlated with those of TF (rho=0.551, p=0.005) and TFPI (rho=0.501, p=0.001); the coagulation markers were also positively associated with each other (rho=0.663, p=0.0004). In healthy subjects, the relations between Cu/Zn SOD, TF and TFPI levels were inverse but not significant, and the direct association between TF and TFPI was nonsignificant either. In conclusion, increased plasma levels of Cu/Zn SOD, the antioxidant enzyme with emerging endothelial cell-protective and antithrombotic properties, may be a novel part of the system counteracting activated extrinsic coagulation system in maintenance HD patients.
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Affiliation(s)
- Krystyna Pawlak
- Department of Nephrology and Internal Medicine, Medical University of Bialystok, 14 Zurawia Street, 15-540 Bialystok, Poland.
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Lassnigg A, Punz A, Barker R, Keznickl P, Manhart N, Roth E, Hiesmayr M. Influence of intravenous vitamin E supplementation in cardiac surgery on oxidative stress: a double-blinded, randomized, controlled study. Br J Anaesth 2003; 90:148-54. [PMID: 12538369 DOI: 10.1093/bja/aeg042] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND I.V. infusions of vitamin E emulsion (all-rac-alpha-tocopherol) may reduce ischaemia-reperfusion injury after elective cardiac surgery. METHODS Forty patients participated in a prospective, double-blind, placebo-controlled, randomized trial, receiving either placebo or four doses (270 mg each) of all-rac-alpha-tocopherol between 16 h before and 48 h after surgery. We determined plasma concentrations of vitamin E, vitamin C, malondialdehyde, creatine kinase, troponin I and interleukin 6 and other measures of clinical outcome. RESULTS Infusion of vitamin E caused normalization of vitamin E plasma concentrations during and after surgery, but had no effect on the early increase in malondialdehyde concentration or the decreases in antioxidative capacity and the water-soluble antioxidant vitamin C. CONCLUSIONS Normalization of plasma vitamin E concentrations with parenteral vitamin E emulsion does not affect biochemical markers of myocardial injury and does not affect clinical outcome after cardiac surgery.
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Affiliation(s)
- A Lassnigg
- Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Wien, Austria.
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Usberti M, Gerardi G, Bufano G, Tira P, Micheli A, Albertini A, Floridi A, Di Lorenzo D, Galli F. Effects of erythropoietin and vitamin E-modified membrane on plasma oxidative stress markers and anemia of hemodialyzed patients. Am J Kidney Dis 2002; 40:590-9. [PMID: 12200812 DOI: 10.1053/ajkd.2002.34919] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Oxidant stress has a pathogenic role in uremic anemia, possibly interfering with erythropoietin (EPO) function and red blood cell (RBC) survival. Therefore, it is expected that antioxidant therapy might exert a beneficial effect on these parameters. METHODS To test this hypothesis, we investigated some oxidant stress indices, anemia levels, and RBC survival in 47 hemodialysis (HD) patients randomly assigned to three groups. Patients in groups A (n = l8) and B (n = 20) were on dialysis therapy using conventional cellulosic and synthetic membranes and were administered high and low doses of recombinant human EPO (rHuEPO), respectively. Patients in group C (n = 9) were dialyzed with vitamin E-modified membranes (CL-Es) and investigated in a two-step prospective study. In step Cl, patients were administered rHuEPO doses similar to those of group A. In step C2, rHuEPO doses were reduced to those of group B. As oxidant stress markers, we determined in plasma the susceptibility of lipids to undergo iron-catalyzed oxidation (reactive oxygen molecules [ROMs] test) and malondialdehyde-4-hydroxynonenal (MDA-4HNE), alpha-tocopherol (alpha-T), total thiol (-SH), and total antioxidant activity. RBC survival was measured using the chromium 51 T/2 technique in 22 patients. RESULTS Results show that: (1) high rHuEPO doses (groups A and C1) were associated with decreased ROM production, low alpha-T levels, and slightly increased -SH levels compared with corresponding groups on low rHuEPO doses (groups B and C2); (2) treatment with CL-Es (group C) increased plasma alpha-T and decreased -SH levels; these data were associated with decreased indices of lipid peroxidation, particularly MDA-4HNE 1evels, only in patients administered low rHuEPO doses; (3) alpha-T concentration influenced RBC survival, which was remarkably decreased in HD patients; patients treated with CL-Es showed a better degree of anemia correction; and (4) alpha-T level correlated negatively with -SH level and seemed to be independent of the extent of peroxidation and oxidizability of plasma lipids. CONCLUSION Both EPO and CL-E can influence plasma antioxidants and, to an extent, lipid peroxidation processes. However, this study shows that even in patients treated with low rHuEPO doses, RBC survival close to normal and sufficient correction of anemia are achieved only when appropriate alpha-T levels are reached.
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Affiliation(s)
- Mario Usberti
- Servizio di Nefrologia e Dialisi Ospedale di Manerbio, Manerbio, Bs, Italy.
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Gerardi G, Usberti M, Martini G, Albertini A, Sugherini L, Pompella A, Di LD. Plasma total antioxidant capacity in hemodialyzed patients and its relationships to other biomarkers of oxidative stress and lipid peroxidation. Clin Chem Lab Med 2002; 40:104-10. [PMID: 11939481 DOI: 10.1515/cclm.2002.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Patients undergoing long-term hemodialysis (HD) exhibit increased levels of oxidative stress, likely contributing to the increased rate of cardiovascular disease. The present study represents a critical evaluation of some of the most widely used oxidative indicators, as applied to the monitoring of hemodialysis-associated oxidative stress. Total plasma antioxidant capacity was determined by two independent procedures, the total antioxidant status (TAS) and the ferric reducing ability of plasma (FRAP) methods. Plasma lipid peroxidation was assessed by determining the peroxidation products malonaldehyde and 4-hydroxynonenal (MDA-4HNE) as well as lipid hydroperoxides ("Fox-2" and "d-ROMs" methods). Total plasma thiols and plasma alpha-tocopherol were also determined. MDA-4HNE levels were higher in HD patients and decreased following HD, possibly due to passive diffusion across dialysis filters. d-ROMs were also higher in HD patients but exhibited a further increase following the dialysis procedure. Serum alpha-tocopherol did not show any significant differences. Plasma thiols were lower in HD patients and were restored following HD. Plasma total antioxidant capacity determined with either method was unexpectedly higher in HD patients compared to controls, and decreased following HD. These data indicate that, of the biomarkers studied, d-ROMs level is the one more accurately reflecting the oxidative alterations taking place in HD patients, while determination of MDA-4HNE fails to detect oxidation occurring during the HD sessions. In addition, our findings point out that the determination of total antioxidant capacity in HD patients is severely affected by the concomitant fluctuations in plasma urate levels and therefore needs careful interpretation.
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Affiliation(s)
- GianMario Gerardi
- III Servizio di Analisi Chimico Cliniche/Laboratorio di Biotecnologie, Spedali Civili di Brescia, Italy
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Clermont G, Lecour S, Cabanne JF, Motte G, Guilland JC, Chevet D, Rochette L. Vitamin E-coated dialyzer reduces oxidative stress in hemodialysis patients. Free Radic Biol Med 2001; 31:233-41. [PMID: 11440835 DOI: 10.1016/s0891-5849(01)00577-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The high incidence of cardiovascular disease in hemodialyzed (HD) patients is well established and oxidative stress has been involved in this phenomenon. The aim of our study was to evaluate if a vitamin E-coated dialyzer could offer protection to HD patients against oxidative stress. Sixteen HD patients were successively assessed for one month (i) on a high biocompatible synthetic dialyzer (AN) and (ii) on a vitamin E-coated dialyzer (VE). Blood samples were taken before and after the dialysis session at the end of each treatment period. HD session conducted with the AN dialyzer was responsible for acute oxidative stress, significantly assessed after HD by a decreased plasma vitamin C level and an increased ascorbyl free radical (AFR)/vitamin C ratio used as an index of oxidative stress. Plasma elastase activity, reflecting neutrophil activation, was also increased; soluble P-selectin, reflecting platelet activation, did not show any variation. The use of the VE dialyzer was associated with a less extended oxidative stress compared with the AN membrane: basal vitamin C level was higher, and after the HD session AFR/vitamin C ratio and elastase activity were not significantly increased. Plasma vitamin E levels were not affected. Our study demonstrates that HD is associated with oxidative stress, which can be partially prevented by the use of a vitamin E-coated dialyzer. Our data suggest that this dialyzer may exert a site-specific scavenging effect on free radical species in synergy with a reduced activation of neutrophils.
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Affiliation(s)
- G Clermont
- L.P.P.C.E., Faculties of Medicine and Pharmacy, Dijon, France.
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