Influence of initiation of maintenance hemodialysis on biomarkers of inflammation and oxidative stress

Pupim, Lara B.; Himmelfarb, Jonathan; McMonagle, Ellen; Shyr, Yu; İkizler, T. Alp

doi:10.1111/j.1523-1755.2004.00656.x

Cited by 117 publications

(112 citation statements)

References 37 publications

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“…Oxidative stress seems to occur early in CKD evolution because oxidative markers have been documented in CKD stage 3 patients (111). Moreover, dialysis treatment seems ineffective in the correction of oxidative stress (114). However, several questions related to CKD oxidative stress remain largely unresolved.…”

Section: Oxidative Stress-an Intricate But Promising Area In Ckdmentioning

confidence: 99%

Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient

Stenvinkel¹,

Carrero²,

Axelsson³

et al. 2008

Clinical Journal of the American Society of Nephrology

491

373

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Premature cardiovascular disease (CVD), including stroke, peripheral vascular disease, sudden death, coronary artery disease, and congestive heart failure, is a notorious problem in patients with chronic kidney disease (CKD). Because the presence of CVD is independently associated with kidney function decline, it appears that the relationship between CKD and CVD is reciprocal or bidirectional, and that it is this association that leads to the vicious circle contributing to premature death. As randomized, placebo-controlled trials have so far been disappointing and unable to show a survival benefit of various treatment strategies, such a lipid-lowering, increased dialysis dose and normalization of hemoglobin, the risk factor profile seems to be different in CKD compared with the general population. Indeed, seemingly paradoxical associations between traditional risk factors and cardiovascular outcome in patients with advanced CKD have complicated our efforts to identify the real cardiovascular culprits. This review focuses on the many new pieces that need to be fit into the complicated puzzle of uremic vascular disease, including persistent inflammation, endothelial dysfunction, oxidative stress, and vascular ossification. Each of these is not only highly prevalent in CKD but also more strongly linked to CVD in these patients than in the general population. However, a causal relationship between these new markers and CVD in CKD patients remains to be established. Finally, two novel disciplines, proteomics and epigenetics, will be discussed, because these tools may be helpful in the understanding of the discussed vascular risk factors.

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Section: Oxidative Stress-an Intricate But Promising Area In Ckdmentioning

confidence: 99%

Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient

Stenvinkel¹,

Carrero²,

Axelsson³

et al. 2008

Clinical Journal of the American Society of Nephrology

491

373

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“…Inflammation is a major driving force for many uremic complications, including PEW. Systemic levels of proinflammatory cytokines are elevated in CKD and ESRD (31) and are thought to play an integral role in the muscle catabolism of patients with ESRD. For example, elevated levels of IL-6 are associated with increased muscle proteolysis, an effect that can be blocked with administration of IL-6 receptor antibodies (32).…”

Section: Prevention Of Pew: a Cause-specific Approachmentioning

confidence: 99%

A Patient with CKD and Poor Nutritional Status

İkizler

2013

Clinical Journal of the American Society of Nephrology

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SummaryProtein energy wasting is common in patients with CKD and ESRD and is associated with adverse clinical outcomes, such as increased rates of hospitalization and death, in these patients. A multitude of factors can affect the nutritional and metabolic status of patients with CKD, including decreased dietary nutrient intake, catabolic effects of renal replacement therapy, systemic inflammation, metabolic and hormonal derangements, and comorbid conditions (such as diabetes and depression). Unique aspects of CKD also confound reliable assessment of nutritional status, further complicating management of this comorbid condition. In patients in whom preventive measures and oral dietary intake from regular meals cannot help them maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is effective in replenishing protein and energy stores. The advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic steroids and exercise, with nutritional supplementation or alone, improve protein stores and represent potential additional approaches for the treatment of PEW. There are several emerging novel therapies, such as appetite stimulants, anti-inflammatory interventions, and anabolic agents.

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“…19 Initiation of MHD does not improve biomarkers of oxidative stress or systemic inflammation, suggesting that maintenance dialysis alone is inadequate to control the proatherogenic metabolic milieu that accompanies uremia. 20 Emerging evidence associating oxidative stress biomarkers with inflammation and cardiovascular risk in patients undergoing MHD has led to several pilot trials of antioxidant regimens, with most studies focusing on use of tocopherols or thiol-containing antioxidants. The tocopherols have long been recognized as potent chain-breaking antioxidants, have potent effects on intracellular signaling pathways, and have been reported to have beneficial metabolic effects in patients undergoing dialysis therapy.…”

mentioning

confidence: 99%

Provision of Antioxidant Therapy in Hemodialysis (PATH)

Himmelfarb

İkizler²,

Ellis³

et al. 2014

Journal of the American Society of Nephrology

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Increased markers of oxidative stress and acute-phase inflammation are prevalent in patients undergoing maintenance hemodialysis therapy (MHD), and are associated with increased mortality and hospitalization rates and decreased erythropoietin responsiveness. No adequately powered studies have examined the efficacy of antioxidant therapies on markers of inflammation and oxidative stress. We tested the hypothesis that oral antioxidant therapy over 6 months would decrease selected biomarkers of acute-phase inflammation and oxidative stress and improve erythropoietic response in prevalent MHD patients. In total, 353 patients were enrolled in a prospective, placebo-controlled, double-blind clinical trial and randomly assigned to receive a combination of mixed tocopherols (666 IU/d) plus a-lipoic acid (ALA; 600 mg/d) or matching placebos for 6 months (NCT00237718); 238 patients completed the study. High-sensitivity C-reactive protein (hsCRP) and IL-6 concentration were measured as biomarkers of systemic inflammation, and F2 isoprostanes and isofurans were measured as biomarkers of oxidative stress. The groups did not significantly differ at baseline. At 3 and 6 months, the treatment had no significant effect on plasma hsCRP, IL-6, F2 isoprostane, or isofuran concentrations and did not improve the erythropoietic response. No major adverse events were related to the study drug, and both groups had similar mortality and hospitalization rates during the study. In conclusion, the administration of mixed tocopherols and ALA was generally safe and well tolerated, but did not influence biomarkers of inflammation and oxidative stress or the erythropoietic response.

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Influence of initiation of maintenance hemodialysis on biomarkers of inflammation and oxidative stress

Abstract: Our data show that initiation of MHD does not have significant influence on plasma concentrations of CRP, IL-6, and IL-10, as well as plasma protein carbonyl content. These findings suggest that MHD is ineffective in controlling inflammation and oxidative stress in uremia.

Cited by 117 publications

References 37 publications

Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient

Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient

A Patient with CKD and Poor Nutritional Status

Provision of Antioxidant Therapy in Hemodialysis (PATH)

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