Comparison Between Hydroperoxides and Malondialdehyde as Markers of Acute Oxidative Injury During Hemodialysis

Abstract

An increased free-radical production has been documented during hemodialysis (HD) particularly when bio-incompatible membranes are utilized. These highly reactive free radicals can cause damage through several pathways, one of the best known being lipid peroxidation. Malondialdehyde (MDA) is a product of lipid peroxidation, which can partly be removed by HD due to its low molecular weight and water solubility. Hydroperoxides are predominantly found in lipid substances, and therefore their removal by HD could be difficult. We evaluated the behavior of these two by-products of lipid peroxidation during HD, comparing their behavior in three different membranes, in order to study their reliability as markers of acute oxidative injury. Fifteen stable HD patients were dialyzed with each of the following membranes: cuprophan, polyamide, and polysulfone, three sessions for every membrane. MDA and hydroperoxides were measured pre-HD and then both from the arterial and venous line at 8, 15, 30, and 240 min. During HD with cuprophan membrane MDA decreased significantly in the venous line compared with the arterial line at 8, 15, and 30 min (P < 0.05). At the end of HD, MDA was significantly reduced compared with MDA pre-HD (P < 0.05). Plasma hydroperoxides increased significantly in the venous line compared with the arterial line at 8, 15, 30, and 240 min (P < 0.05). At the end of HD, hydroperoxides had increased significantly as compared with pre-HD (P < 0.05). When the polyamide and polysulfone membranes were used, the behavior of MDA was similar to that found with cuprophan. Hydroperoxides were unchanged during HD using both membranes. MDA is not a reliable marker of acute oxidative injury during HD as it is removed during HD. Hydroperoxide measurement is a better marker of acute oxidative injury during HD.

Reactive Oxygen Metabolites: A Link between Oxidative Stress and Inflammation in Patients on Hemodialysis

“…The present study was conducted in order to examine if d-ROMs concentration can be related to the degree of inflammation and compare this relation with that of other oxidative markers. The d-ROMs levels has been characterized by certain investigators as a very reliable parameter for the evaluation of oxidative stress, exhibiting a strong direct correlation with lipid hydroperoxides [14,15] . The latter can be ascribed mainly to the determination assay, since the treatment of serum with iron salts assists the decomposition of lipid hydroperoxides to lipid radical species [21] .…”

“…The latter can be ascribed mainly to the determination assay, since the treatment of serum with iron salts assists the decomposition of lipid hydroperoxides to lipid radical species [21] . An additional advantage of d-ROMs is that it does not follow the post-dialysis fate of the diffusible, hydrophilic and low-molecular-weight products of lipid peroxidation, MDA and 4-hydroxyalkenals, across the dialysis filters [14,15] . Moreover, it is not affected by the significant changes of serum antioxidants and mainly those of uric acid concentration during dialysis, as applies to other TAC oxidative markers such as TAC and FRAP [5,22] .…”

“…Recently, the levels of hydroperoxides measured by the 'd-ROMs' (reactive oxygen metabolites) method is proved to be a very accurate marker, reflecting the oxidative alterations taking place in HD patients [14,15] . In the pres-ent study, we have investigated the association of C-reactive protein (CRP) with the novel marker d-ROMs as well as with other markers of oxidative stress, such as the levels of total antioxidant capacity (TAC), MDA and 4-hydroxyalkenals.…”

Cardiovascular Risk Factors in End-Stage Renal Disease Patients: The Impact of Conventional Dialysis versus Online-Hemodiafiltration

“…Products of lipid peroxidation, such as malondialdehyde and hydroperoxide, are increased in CKD, being the latter reported as a reliable marker of oxidative injury during HD [38]. Advanced oxidation protein products accumulate in CKD, especially in HD patients, and have been reported as independent risk factors for ischemic heart disease [39].…”

Oxidative Stress Markers and C-Reactive Protein in Pediatric Patients on Hemodialysis

“…Patients on hemodialysis (HD) are constantly exposed to oxidative stress [3][4][5] . This is mostly attributed to bioincompatibility-type reactions, originating from the di-…”