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.
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