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      Effect of Oxidative Stress in Hemodialysed Patients

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          Abstract

          Aims, subjects and methods

          Markers of oxidative stress and inflammatory activation of endothelium, as well as the adipose tissue secreted adipokines, e.g. adiponectin show altered pattern in renal failure. However, their internal relations have not been fully evaluated in this special patient population.

          In our cross sectional study, beside the routine clinical and biochemical parameters, plasma malondialdehyde, glutathione (GSH), catalase, total peroxidase, as well as serum E-selectin and adiponectin were measured in 70 hemodialysed (HD) patients.

          Results

          GSH showed negative correlations with systolic and diastolic blood pressure (BP) values, while a positive one with HDL-cholesterol level, as expected. Interestingly, the level of sE-selectin was inversely correlated only with the age. In multiple regression analyses where anthropometric, BP and laboratory parameters were included and sE-selectin was the dependent variable, the inverse association between the age and level of sE-Selectin turned out being an independent factor.

          Conclusions

          In HD kidney failure patients of the biochemical cardiovascular risk markers those related to oxidative stress, endothelial dysfunction, or altered adipokine homeostasis are not necessarily strongly associated. Larger studies may be needed to confirm our novel observation, a negative and independent correlation of age to sE-Selectin level.

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          Most cited references17

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          Estimation of product of lipid peroxidation (malonyl dialdehyde) in biochemical systems.

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            Alteration in plasma antioxidant capacity in various degrees of chronic renal failure.

            To obtain a more comprehensive profile of extracellular antioxidant capacity in chronic renal failure (CRF), markers of oxidative stress (malondialdehyde, MDA and hydrogen peroxide), protein SH groups (as an important chain-breaking antioxidant) and activity of antioxidant enzymes (glutathione peroxidase, [GPX], catalase and superoxide dismutase, [SOD]) were studied in plasma of 36 non-dialyzed patients with various degrees of CRF and 10 hemodialyzed (HD) patients. The results show that plasma MDA concentrations significantly increase with the severity of kidney dysfunction (r = -0.543, p 0.05). Plasma SOD activity increased in CRF patients with the progression of renal insufficiency (r = -0.370, p < 0.05). On the other hand, plasma GPX activity decreased progressively in strong correlation with endogenous CCr (r = 0.712, p < 0.001). However, despite this imbalance between extracellular SOD and GPX activities, plasma concentration of hydrogen peroxide remained unchanged in non-dialyzed CRF patients. Catalase activity in non-dialyzed CRF patients was increased, suggesting the significant involvement of catalase in the regulation of plasma hydrogen peroxide level. In hemodialyzed patients significantly lower plasma catalase activity, associated with higher hydrogen peroxide levels, was found. It seems reasonable to assume that the imbalance in the activity of extracellular antioxidant enzymes in chronic renal failure may result in accumulation of free radical species, and in unscheduled oxidation of susceptible molecules.
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              Serum Levels of Soluble Adhesion Molecules in Chronic Renal Failure and Dialysis Patients

              Besides cell-bound adhesion molecules, which are of fundamental importance to a large number of physiological and pathological processes, soluble forms of adhesion molecules have been detected in the circulating blood in recent years. Circulating soluble adhesion molecules appear to be biologically active, and raised levels have been reported in a variety of disorders. In the present study, we used ELISA to measure the serum levels of four soluble adhesion molecules in 23 undialyzed patients with chronic renal failure (CRF), 13 patients on continuous ambulatory peritoneal dialysis (CAPD), 17 on chronic hemodialysis (HD) and 18 healthy controls having a similar mean and distribution of ages. The investigated soluble (s) molecules included intercellular adhesion molecule 1 (sICAM-1), vascular cell adhesion molecule 1 (sVCAM-1), sE-selectin and sP-selectin. sICAM-1 was found to be elevated in patients with CRF (p < 0.05), on CAPD (p < 0.02) and HD (p < 0.0001) compared with the controls but levels did not differ between the three patient groups. The higher sVCAM-1 values found in CRF (p < 0.02), CAPD (p < 0.05) and HD (p < 0.0001) as compared to controls again failed to differentiate the three groups of patients. Soluble E-selectin was also raised in the three groups (p < 0.0001) with no difference between them. Increased sP-selectin was found in CRF (p < 0.05), CAPD (p < 0.02) and in HD patients (p < 0.0001) compared to controls, and levels in HD were significantly higher (p < 0.02) than in CRF patients. Predialysis serum molecule levels did not differ between HD patients treated with cuprophan or with polyacrylonitrile dialyzers. HD sessions with both dialyzers had no effect on sICAM-1, while a decrease (p < 0.02) in sP-selectin was found after dialysis with cuprophan. In undialyzed patients with CRF, regression analysis showed a strong linear correlation between serum creatinine and serum levels of each soluble molecule. These results demonstrate that serum levels of soluble adhesion molecules ICAM-1, VCAM-1, E-selectin and P-selectin are elevated in both undialyzed patients with CRF and patients on CAPD or HD. The elevated serum levels of these proteins probably reflect inadequate clearance as well as enhanced synthesis/release.
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                Author and article information

                Journal
                EJIFCC
                EJIFCC
                eJIFCC
                EJIFCC
                The Communications and Publications Division (CPD) of the IFCC
                1650-3414
                20 July 2011
                July 2011
                : 22
                : 2
                : 45-51
                Affiliations
                [1 ] Institute of Laboratory Medicine, School of Medicine, University of Pecs , Pecs, Hungary
                [2 ]FMC Dialysis Center , Pecs, Hungary
                [3 ]1st Department of Medicine, School of Medicine, University of Pecs , Hungary
                Author notes
                1st Department of Medicine, School of Medicine, University of Pecs, Hungary, H-7624 Pecs, Ifjusag ut 13., Hungary; 36(72) 536-000/1771, 36(72) 536-148; laszlo.bajnok@ 123456aok.pte.hu
                Article
                ejifcc-22-045
                4975287
                1bad0649-69bc-4831-9e24-b003e5c0a435
                Copyright © 2011 International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). All rights reserved.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Figures: 0, Tables: 4, Equations: 0, References: 20, Pages: 7
                Categories
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