Oxidative Stress in Patients with Advanced CKD and Renal Replacement Therapy: The Key Role of Peripheral Blood Leukocytes

Vida, Carmen; Oliva, Carlos; Yuste, Claudia; Ceprián, Noemí; Jara, Paula; Valera, G. Guerra; Pablos, Ignacio González de; Morales, Enrique; Carracedo, Julia

doi:10.3390/antiox10071155

Cited by 16 publications

(9 citation statements)

References 61 publications

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“…The increased oxidative stress observed in hemodialysis patients could play a significant role in mortality and infectious morbidity, particularly among patients with an elevated malnutrition‐inflammation status. Malnutrition could be aggravated by hemodialysis due to loss of micronutrients during the procedure, dietary restrictions, and enhanced oxidative‐inflammatory stress 39 …”

Section: Discussionmentioning

confidence: 99%

Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes

Mudrik-Zohar

Alon

Nacasch

et al. 2023

Seminars in Dialysis

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IntroductionPatients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.ObjectiveThe objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.MethodsThis prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12‐Myristate‐13‐Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24‐month follow‐up period were obtained from electronic medical records.ResultsPhagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI‐PMA percentiles. Patients in the lowest (25th) MFI‐PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all‐cause mortality was 8.85. In multivariate analysis, the MFI‐PMA percentile and ischemic heart disease were the strongest predictors of all‐cause mortality (p = 0.02 and p = 0.005, respectively).ConclusionsLow MFI‐PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.

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Section: Discussionmentioning

confidence: 99%

Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes

Mudrik-Zohar

Alon

Nacasch

et al. 2023

Seminars in Dialysis

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“…In general, redox homeostasis is critical for cell viability, activation, proliferation, and organ function [ 36 , 37 ]. Further, the accumulation of ROS is associated with the pathogenesis of CKD [ 38 , 39 , 40 , 41 ] and influences cellular function and mortality in PD patients [ 1 , 42 , 43 , 44 , 45 ]. Our results showing increased oxidative DNA-damage are consistent with previous studies demonstrating increased damage due to attenuated defense mechanisms [ 7 , 46 ] and studies showing that both hemodialysis and peritoneal dialysis induces oxidative DNA-damage in patients or in peritoneal mesothelial cells of PD patients [ 44 , 47 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Enhanced Oxidative DNA-Damage in Peritoneal Dialysis Patients via the TXNIP/TRX Axis

et al. 2022

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Peritoneal dialysis (PD) is an effective method of renal replacement therapy, providing a high level of patient autonomy. Nevertheless, the long-term use of PD is limited due to deleterious effects of PD fluids to the structure and function of the peritoneal membrane leading to loss of dialysis efficacy. PD patients show excessive oxidative stress compared to controls or chronic kidney disease (CKD) patients not on dialysis. Therefore, defense systems against detrimental events play a pivotal role in the integrity of the peritoneal membrane. The thioredoxin-interacting-protein (TXNIP)/thioredoxin (TRX) system also plays a major role in maintaining the redox homeostasis. We hypothesized that the upregulation of TXNIP negatively influences TRX activity, resulting in enhanced oxidative DNA-damage in PD patients. Therefore, we collected plasma samples and human peritoneal biopsies of healthy controls and PD patients as well. Using ELISA-analysis and immunohistochemistry, we showed that PD patients had elevated TXNIP levels compared to healthy controls. Furthermore, we demonstrated that PD patients had a reduced TRX activity, thereby leading to increased oxidative DNA-damage. Hence, targeting the TXNIP/TRX system as well as the use of oxidative stress scavengers could become promising therapeutic approaches potentially applicable in clinical practice in order to sustain and improve peritoneal membrane function.

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“…It has been demonstrated that significantly enhanced oxidative stress and damage in peripheral and mononuclear leukocytes and increased plasma levels of xanthine oxidase, oxidized glutathione (GSSG), and malondialdehyde; decreased superoxide dismutase, catalase, glutathione peroxidase, and glutathione (GSH); and altered GSSG/GSH balance were found in non-dialysis-dependent-CKD, and hemodialysis patients compared to healthy controls ( Vida et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the combination effect of rutin and vitamin C supplementation on the oxidative stress and inflammation in hemodialysis patients

et al. 2022

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Background: Hemodialysis (HD) patients are at risk of malnutrition, cardiovascular complications, and all-cause mortality due to oxidative stress and inflammation. Some studies have demonstrated that rutin attenuates oxidative stress and inflammation in CKD rats, but its effects in HD patients are unknown to date.Aim: The aim of this study was to evaluate the effect of rutin and vitamin C versus vitamin C alone on oxidative stress and inflammation in HD patients.Methods: A prospective randomized, open-label, controlled trial enrolled on hundred and five HD patients divided into three groups as follows: patients in group 1 were given a rutin/vitamin C combination (Ruta C group as the combination trade name is known as Ruta C 60 tablets), patients in group 2 were given vitamin C (1 g) (vitamin C group), and group 3 was the control group; the study period was 16 weeks. The following were assessed at baseline and at the end of the study: serum malondialdehyde (MDA), glutathione peroxidase (GPx), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), lipid profile levels, and erythrocyte sedimentation rate.Results: It was found that vitamin C significantly increased serum GPx in group 2 (p = 0.001) compared to a non-significant result in both group 1 and 3; in addition, serum MDA and TNF-α values had decreased significantly in the three groups compared to their baselines; however, a non-significant difference was seen among the studied groups at the end of the study. On the other hand, MDA levels were reduced by 50% in interventional groups compared to 28% in the control group, while the Ruta C group showed an 80% reduction in the level of TNF α compared to the 78% reduction observed in the vitamin C group, and finally, the interventional drugs showed a significant improvement in the lipid profile.Conclusion: Vitamin C supplementation alone for 16 weeks had a potential effect on the antioxidant’s GPx activity. Moreover, it was reported that both vitamin C alone or the rutin/vitamin C combination (Ruta C) showed a protective role against lipid peroxidation, evidenced by the reduced levels of MDA. Finally, rutin had a favorable synergistic effect with vitamin C in reducing TG and TNF-α levels and increasing HDL-C level.

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Oxidative Stress in Patients with Advanced CKD and Renal Replacement Therapy: The Key Role of Peripheral Blood Leukocytes

Cited by 16 publications

References 61 publications

Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes

Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes

Enhanced Oxidative DNA-Damage in Peritoneal Dialysis Patients via the TXNIP/TRX Axis

Evaluation of the combination effect of rutin and vitamin C supplementation on the oxidative stress and inflammation in hemodialysis patients

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