Comparative Effects of Silymarin and Vitamin E Supplementation on Oxidative Stress Markers, and Hemoglobin Levels Among Patients on Hemodialysis

Abstract

Background The incidence of accelerated atherosclerosis among patients on hemodialysis is very high and oxidative stress is a potentially major contributor to their morbidity and mortality. Objective To evaluate the effects of Silymarin and/or vitamin E on oxidative stress markers and hemoglobin level in patients on hemodialysis. Methods Eighty patients on hemodialysis were randomized into 4 groups: Group 1 received Silymarin 140 mg 3 times daily; Group 2 received Vitamin E 400 IU/day; Group 3 received Silymarin 140 mg 3 times daily and Vitamin E 400 IU/day; Group 4 was the control. Samples were obtained at baseline and on day 21 for measurement of malondialdehyde (MDA), RBC glutathione peroxidase (GPX), and hemoglobin. Results Combination of Silymarin and vitamin E led to a reduction in the MDA levels (7.84±1.84 vs. 9.20±2.74 nmol/ml; p=0.008). There was a significant increase in RBC GPX levels in all treatment groups compared to controls after 3 weeks. This was more pronounced in the group receiving combination compared to vitamin E or the control group (5.78±3.51, 4.22±1.63, and 3.16±1.89 Iu/gr-Hb respectively; p<0.001). There was also a significant increase in mean hemoglobin of all treatment groups compared to control. Conclusions Oral supplementation with Silymarin and vitamin E leads to reduction in MDA, increase in RBC GPX and increase in hemoglobin levels in patients with ESRD. Studies with larger sample sizes and longer follow-up are required to investigate the effect of Silymarin on cardiovascular outcomes, and erythropoietin requirement.

Effects of palmitoylethanolamide and silymarin combination treatment in an animal model of kidney ischemia and reperfusion

“…The data indicate first that pretreatment in high-risk groups may have benefit in reducing IRI, but, in our opinion, these findings may be of relevance not only for I/R damage, but also for other conditions of kidney damage, including CKD. The rational supporting PEA action in CKD has been recently discussed in our review (Impellizzeri et al, 2014), while for silymarin extensive preclinical evidence and clinical data are already available (Fallahzadeh et al, 2012;Roozbeh et al, 2011). Since both agents are characterized by low toxicity, further work is warranted and we hypotetize that further studies will document the efficacy of the combination in other experimental models and in the clinical setting as well.…”

Effects of Silybum marianum (L.) Gaertn. (silymarin) extract supplementation on antioxidant status and hs-CRP in patients with type 2 diabetes mellitus: A randomized, triple-blind, placebo-controlled clinical trial

“…According to the findings of previous studies, the supplementation procedure for silymarin was set at three 140 milligrams (mg) tablets per day (Roozbeh et al 2011). The experimental group received 140 mg silymarin supplement three times daily with main meals for 45 days.…”

“…Silymarin in rats with alloxan-induced diabetes mellitus significantly increase the activity of antioxidant enzymes such as SOD, GPX and catalase (CAT), and prevents renal tissue damage (Soto et al 2003(Soto et al , 2010. Oral supplementation of end stage renal disease patients with Silybum marianum (Livergol R ) extract and vitamin E led to a reduction of MDA and increases in red blood cell (RBC) GPX levels (Roozbeh et al 2011). Regarding the above-mentioned experimental studies (Soto et al 2003(Soto et al , 2010Wellington and Harvis 2001), silymarin potentially has antioxidant and anti-inflammatory characteristics; however, studies investigating the effects of silymarin on stress oxidative and inflammatory biomarkers have been limited to animal models and no clinical trials have been performed on diabetic patients.…”

“…Silymarin, the active component of the milk thistle plant (Silybum marianum (L.) Gaertn.) (Russell 2004) is a polyphenolic flavonolignan with potentially antioxidant properties that comprises four flavonolignans isomers: silybin, isosilybin, silydianin and silychristin (Roozbeh et al 2011). Silymarin has shown protective effects against oxidative lipid peroxidation in several experimental models and in human hepatic damage through the scavenging of free radical and increasing reduced glutathione (GSH) (Wellington and Harvis 2001).…”

Potential Renoprotective Effects of Silymarin Against Nephrotoxic Drugs: A Review of Literature

“…Silymarin may exert positive effects in the management of patients with renal insufficiency. Recently, Roozbeh et al reported that treatment of hemodialysis patients with silymarin, alone or in combination with vitamin E, significantly decreased plasma MDA concentration and increased red blood cell glutathione peroxidase and hemoglobin levels (32). Silymarin also reduced kidney damage and restored activities of superoxide dismutase, glutathione peroxidase and catalase enzymes in rats with alloxan-induced diabetes (33).…”