Background: End stage renal disease (ESRD) is associated with an increase in oxidative stress, cardiovascular disease and cancer. The main treatment for ESRD is haemodialysis (HD), which itself induces repetitive bouts of oxidative stress through membrane biocompatibility and endotoxin challenge. The resulting higher levels of reactive oxygen species in turn produce increased levels of oxidative DNA damage leading to genomic instability which may influence the higher risk of cancer reported in HD patients. Our aims were to measure levels of oxidative DNA damage in HD patients and in age and gender matched control volunteers. Methods: Thirty eight patients receiving HD in the Western Health and Social Services Trust (WHSCT) and 8 healthy volunteers were recruited. Volunteers gave informed consent and non-fasting morning blood samples were taken and assessed for DNA disruption using the comet assay modified to identify oxidative specific damage. Results: The HD patients had significantly elevated levels of alkaline DNA damage (19.46% ± 1.37% vs 3.86% ± 1.36% tail DNA, p < 0.05) and oxidative DNA damage formamidepyrimidine DNA glycosilase (5.81% ± 1.08% vs 1.23% ± 0.43% tail DNA, p < 0.01) and endonuclease III (6.04% ± 1.00% vs 1.98% ± 0.70% tail DNA, p < 0.01) compared to controls, respectively. A positive correlation was observed between the duration on dialysis (months) and levels of Endo III specific damage (p = 0.041). Conclusion: The significant increase in oxidative DNA damage and the positive correlation with duration of HD treatment and Endo III damage may contribute to the increased cancer risk observed in this patient group. Studies are required to investigate the best way to reduce this damage.
These results are consistent with a beneficial effect of the cocktail on antioxidant enzyme activity and may contribute to an indication for large-scale studies to assess clinical outcome measures.
There is a high prevalence of malnutrition among HD patients due to the restrictive diet, dialysis loses and reduced appetite (1) . Sub-optimal nutritional status is found to be major risk factors for morbidity and mortality in Haemodialysis (HD) patients (2) . These factors lead to high levels of oxidative stress in HD patients (3) .The study aims to analyse food intake and compare recorded dietary intakes to Recommended Nutrient Intakes (RNI) in males and females undergoing HD treatment.Twelve volunteers were recruited following ethical approval. Four day food diaries were completed (two dialysis and two non-dialysis days) and checked by the renal dietician all data were double entered to WISP (Wisp version 3, Tinuviel Software, Warrington) and exported to SPSS (Statistical Package for the Social Sciences, version 17.00) for statistical analysis.Macronutrient intakes were unbalanced with a mean protein intake for all HD patients above the RNI and CHO and fat intake lower. The table below details the micronutrients that were below the RNI, of particular significance for females: a reduced folate, vitamin D, iron, selenium and copper with an elevated vitamin C intake. Males had a similar profile however vitamin C and iron were adequate.
End stage renal disease is associated with an increase in oxidative stress, cardiovascular disease and cancer. The main treatment for this condition is haemodialysis, which itself induces repetitive bouts of oxidative stress through membrane biocompatibility and endotoxin challenge.Micronutrient supplementation has been found to have a beneficial effect on oxidative stress levels in haemodialysis patients. However, few long term studies of nutritional supplements containing both folic acid and antioxidant vitamins at physiological and not pharmacological levels have been undertaken.The aim of this investigation was to examine the effect of a micronutrient supplement (containing folic acid, B vitamins, antioxidant vitamins and trace elements) on folate and homocysteine levels in haemodialysis patients.Ethical permission was obtained from the Office of Research Ethics Committee Northern Ireland and Governance was obtained from the Wes teen Health and Social Care Trusty. Forty established haemodialysis patients gave informed consent and were then randomised (double blind) to receive daily either a placebo or treatment capsule.Blood sample were collected and processed at baseline and 12 months to measure homocysteine using an immunoassay (1) , plasma folate and whole blood folate were measured by a microbiological assay (2) . 37 volunteers completed the intervention one patient died and two had transplants. We report a significant increase in plasma folate (5.61°3.6 vs. 23.39°9.84 ng/ml; P > 0.0001) and whole blood folate (144.04°80.55 vs. 341.61°250.11 ng/ml; P > 0.002) and a significant reduction in homocysteine (25.73.°9.48 vs. 19.74°4.3 mol/l; P > 0.05), equating to a 31 % reduction.The significant increase observed in the folate measurements together with the significant reduction in homocysteine support the need for micronutrient supplementation among haemodialysis patients. By lowering homocysteine levels and increasing folate it is proposed that patients will be better protected against cardiovascular complications and the oxidative stress that accompanies their treatment regimes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.