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      Status of antioxidant and homocysteine-lowering vitamins related to cardiovascular diseases in hemodialysis patients

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          Abstract

          Background and aim

          Cardiovascular disease is the major cause of mortality in hemodialysis patients. Oxidative stress and hyperhomocysteinemia may contribute to an increased risk of CVD. Therefore, we assessed the status of antioxidant and homocysteine-lowering vitamins related to cardiovascular disease in hemodialysis patients at Vasei hospital in Sabzevar.

          Methods

          In this cross-sectional study, we enrolled 75 hemodialysis patients by using census method at Vasei Hospital in Sabzevar (Iran) in 2014. After measuring height and body weight, food intake was assessed by a 24-hour dietary recall questionnaire for at least two days (a non-dialysis and dialysis day), and food frequency was recorded with Nutritionist IV software. Data were analyzed by SPSS version 16, using descriptive statistical tests, one sample t-test and independent samples t-test and p<0.05 was considered statistically significant.

          Results

          This study was carried out on 75 patients. Mean age and BMI of patients were 49.95±17.22 years and 20.04±3.38 kg/m 2, respectively. Intake of all vitamins with the exception of vitamin B12 in hemodialysis patients studied, were less than the recommended dietary allowance (RDA) (p<0.05).

          Conclusion

          According to the survey, consumption of antioxidants and B-vitamins related to cardiovascular disease was less than RDA in hemodialysis patients.

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          Effect of hemodialysis on total antioxidant capacity and serum antioxidants in patients with chronic renal failure.

          Lisa Jackson, J H Lightbody, C. Loughrey … (1995)
          Cardiovascular disease is the major cause of mortality in patients receiving hemodialysis for chronic renal failure. Increased lipid peroxidation and depletion of chain-breaking antioxidants may contribute to increased risk of atherosclerosis. We have therefore assessed the effect of a single episode of hemodialysis on antioxidant status in 22 patients and control subjects. Overall, total antioxidant capacity of serum was increased in dialysis patients, but there was a marked reduction after hemodialysis [571 +/- 31 vs 342 +/- 22 mumol/L Trolox (water-soluble vitamin E analog) equivalents, P < 0.001]. The increase in total antioxidant capacity before hemodialysis was almost entirely due to relatively high serum urate. Among individual chain-breaking antioxidants, dialysis led to a decrease in urate (398 +/- 15 vs 136 +/- 12 mumol/L, P < 0.001), ascorbate (10.5 +/- 1.7 vs 5.9 +/- 1.0 mumol/L, P < 0.01), and lipid-corrected tocopherol (4.70 +/- 0.56 vs 4.26 +/- 0.39 mumol/mmol cholesterol, P < 0.05). Protein thiol groups increased after dialysis (328 +/- 16 vs 422 +/- 22 mumol/L, P < 0.001), whereas albumin remained unchanged (40.1 +/- 1.1 vs 41.0 +/- 1.6 g/L, not significant). Although total antioxidant capacity of serum is increased in hemodialysis patients, depletion of key chain-breaking antioxidants may lead to accelerated atherogenesis.
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            Antioxidant therapy in hemodialysis patients: a systematic review.

            Jeff Coombes, Robert G. Fassett (2012)
            Antioxidants have been used as therapies to decrease oxidative stress and improve CVD risk in hemodialysis (HD) patients. A systematic search of the Medline database (search date 30 April 2011) found 56 studies investigating the effects of antioxidant therapies on biomarkers of oxidative stress (53 studies) or clinical outcomes (3 studies). The majority were small trials using a nonrandomized open-label design with a single HD group (no HD controls). Alpha-tocopherol was the most investigated antioxidant, with 20/25 studies reporting that this vitamin decreased oxidative stress, and one clinical outcome trial in 196 patients finding that it protected against secondary CVD. Studies using vitamin C were more equivocal, with 4/11 showing decreased oxidative stress and one clinical outcome trial showing no effect on morbidity or mortality. N-acetylcysteine was the most efficacious agent, with 4/4 studies indicating a decrease in oxidative stress and one trial (n=134) showing reduced CVD events. Seven studies have used therapy containing a combination of antioxidants, with five of these reporting decreased oxidative stress. Most intervention studies in HD patients, such as statin therapy and increased dialysis dose, have failed to show improvement in CVD outcomes. Two intervention trials using different antioxidants have found CVD benefits, suggesting that this line of therapy is effective in this resistant population. These studies require validation in larger, adequately powered trials.
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              Alpha-tocopherol supplementation decreases the oxidative susceptibility of LDL in renal failure patients on dialysis therapy.

              Kazi Islam, Dawn O’Byrne, Sridevi Devaraj … (2000)
              Atherosclerotic cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD) who have undergone dialysis treatment. The oxidation of low density lipoprotein (LDL) appears to be a crucial step in the pathogenesis of atherosclerosis. The increased oxidative stress and attendant increased oxidizability of lipoproteins, such as LDL could contribute to the accelerated atherosclerosis in dialysis patients. Since alpha-tocopherol (AT) is the major antioxidant in LDL, the aim of the present study was to test the effectiveness of RRR-AT supplementation (800 I.U. per day) for 12 weeks on the susceptibility of LDL to oxidation. The study subjects comprised patients with chronic renal failure on hemodialysis (HD), peritoneal dialysis (PD), and age and sex matched controls (C). Plasma fatty acids, lipoproteins and AT levels were measured in these subjects before and after supplementation. Also, LDL AT and oxidizability was studied. LDL was isolated by ultracentrifugation at baseline and after 12 weeks of supplementation, and subjected to a 5-h time course of copper catalyzed oxidation. Oxidation was measured by the formation of conjugated dienes (CD) and lipid peroxides (LP). Supplementation with AT did not alter the plasma lipid or lipoprotein profile of these subjects. Plasma lipid-standardized AT and LDL AT concentrations were not different among the groups at baseline. AT supplementation significantly increased plasma lipid-standardized AT (C=150%, HD=149%, PD=217%, P<0.001) and LDL AT concentrations (C=94%, HD=94%, PD=135%, P<0.003). AT enrichment of LDL resulted in a significant prolongation in conjugated diene lag phase in all groups (C=34%, HD=21%, PD=54%, P<0.02). Lipid peroxide lag phase was also increased significantly in C (27%,) and PD (40%) groups after AT supplementation (P<0.01). There was a significant positive correlation between plasma lipid standardized AT and lag phase (r=0. 54, P=0.0003). Overall, AT decreased the susceptibility of LDL to oxidation in patients with chronic renal failure but the benefit appears to be greater in patients on PD. Therefore, AT supplementation may also provide a measure of protection against CAD in patients with chronic renal failure on dialysis therapy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Electron Physician
                Journal ID (iso-abbrev): Electron Physician
                Journal ID (publisher-id): Electronic physician
                Title: Electronic Physician
                Publisher: Electronic physician
                ISSN (Electronic): 2008-5842
                Publication date Collection: July 2017
                Publication date (Electronic): 25 July 2017
                Volume: 9
                Issue: 7
                Pages: 4895-4898
                Affiliations
                [1 ]Ph.D. of Nutrition, Associate Professor, Department of Nutrition & Biochemistry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
                [2 ]Department of Obstetrics & Gynecology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
                [3 ]Department of Anesthesiology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
                [4 ]Department of Operating Room & Anesthesia, Faculty Member of Paramedic, Sabzevar University of Medical Sciences, Sabzevar, Iran
                Author notes
                Corresponding author: Roya Akbarzadeh, Sabzevar University of Medical Sciences, Sabzevar, Iran. Tel: +98.5144018353, Email: roakbarzadeh53@ 123456gmail.com
                Article
                Publisher ID: epj-09-4895
                DOI: 10.19082/4895
                PMC ID: 5587010
                SO-VID: 7ce287e6-9813-4ffb-8854-b7af09a528b7
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 18 March 2016
                Date accepted : 12 February 2017
                Categories
                Subject: Original Article

                Keywords: antioxidant,b-vitamin,hemodialysis
                Data availability:
                Keywords: antioxidant, b-vitamin, hemodialysis

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