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      Evaluation of Assays for Measurement of Serum (Anti)oxidants in Hemodialysis Patients

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          Abstract

          Background. Various biomarkers and assays have been used for assessment of (anti)oxidant status in hemodialysis patients, including those intended for measurement of serum total (anti)oxidants, most often as a part of panel biomarkers. Methods. Serum (anti)oxidant status was measured in 32 chronically hemodialyzed patients and in 47 healthy persons, using two oxidations and three antioxidant assays. Results. The patients before the hemodialysis session have had higher values of total oxidants in comparison to the healthy persons, with a further increase during the hemodialysis. These findings were confirmed with both oxidation assays, but they differ in the percentage of increase and the statistical significance. All three antioxidant assays showed significantly higher values of the total serum antioxidants in the patients before the hemodialysis session in comparison to the healthy persons, and their significant decrease during the hemodialysis. However, the assays differ in the percentage of decrease, its statistical significance, and the correlations with uric acid. Conclusion. The variability of results of total (anti)oxidants which are obtained using different assays should be taken into account when interpreting data from clinical studies of oxidative stress, especially in complex pathologies such as chronic hemodialysis.

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          Vascular incompetence in dialysis patients--protein-bound uremic toxins and endothelial dysfunction.

          Noemie Jourde-Chiche, Laetitia Dou, Claire Cerini … (2015)
          Patients with chronic kidney disease (CKD) have a much higher risk of cardiovascular diseases than the general population. Endothelial dysfunction, which participates in accelerated atherosclerosis, is a hallmark of CKD. Patients with CKD display impaired endothelium-dependent vasodilatation, elevated soluble biomarkers of endothelial dysfunction, and increased oxidative stress. They also present an imbalance between circulating endothelial populations reflecting endothelial injury (endothelial microparticles and circulating endothelial cells) and repair (endothelial progenitor cells). Endothelial damage induced by a uremic environment suggests an involvement of uremia-specific factors. Several uremic toxins, mostly protein-bound, have been shown to have specific endothelial toxicity: ADMA, homocysteine, AGEs, and more recently, p-cresyl sulfate and indoxyl sulfate. These toxins, all poorly removed by hemodialysis therapies, share mechanisms of endothelial toxicity: they promote pro-oxidant and pro-inflammatory response and inhibit endothelial repair. This article (i) reviews the evidence for endothelial dysfunction in CKD, (ii) specifies the involvement of protein-bound uremic toxins in this dysfunction, and (iii) discusses therapeutic strategies for lowering uremic toxin concentrations or for countering the effects of uremic toxins on the endothelium. Journal compilation © 2011 Blackwell Publishing.
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            Plasma total antioxidant capacity in hemodialyzed patients and its relationships to other biomarkers of oxidative stress and lipid peroxidation.

            L. Di Ciaccio, L Sugherini, Giuliana Martini … (2002)
            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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              Understanding iron: promoting its safe use in patients with chronic kidney failure treated by hemodialysis.

              Nosratola D. Vaziri (2013)
              Although judicious use of intravenous iron preparations is an indispensable part of anemia treatment in hemodialysis patients, their excessive and indiscriminate use can have insidious but serious adverse consequences. With recent implementation of the bundling reimbursement policy, use of intravenous iron preparations in the hemodialysis population has markedly increased. Excessive use of these agents potentially can exacerbate oxidative stress, inflammation, endothelial dysfunction, cardiovascular disease, and immune deficiency and potentially increases the risk of microbial infections in this population. Most of these adverse effects are mediated by iron-catalyzed generation of reactive oxygen species and the resultant cell injury and dysfunction. This review is intended to provide an overview of the nature and mechanisms of the adverse effects of iron overload and call for the judicious use of these vitally important products. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biomed Res Int
                Journal ID (iso-abbrev): Biomed Res Int
                Journal ID (publisher-id): BMRI
                Title: BioMed Research International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2314-6133
                ISSN (Electronic): 2314-6141
                Publication date (Print): 2014
                Publication date (Electronic): 19 May 2014
                Volume: 2014
                Electronic Location Identifier: 843157
                Affiliations
                1Faculty of Medical Sciences, Goce Delcev University, 2000 Stip, Macedonia
                2National Institute for Public Health and the Environment, 3721 MA, Bilthoven, The Netherlands
                3General City Hospital, 1000 Skopje, Macedonia
                Author notes

                Academic Editor: Patrizia Cardelli

                Author information
                http://orcid.org/0000-0002-4300-4891
                Article
                DOI: 10.1155/2014/843157
                PMC ID: 4055181
                SO-VID: 74ce51bb-51c5-4311-9cb7-4bae7179eaea
                Copyright © Copyright © 2014 Tatjana Ruskovska et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 2 February 2014
                Date revision received : 24 April 2014
                Date accepted : 5 May 2014
                Funding
                Funded by: Military Hospital in Skopje, Republic of Macedonia
                Categories
                Subject: Research Article

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