Influence of Epoietinum Therapy on the Oxidative Stress in Haemodialysis Patients

Abstract

Background: The causes of oxidative stress in haemodialysis (HD) patients are still controversial. Beside the uraemic state and dialysis-related factors, adjuvant drug therapies such as epoietinum (rHuEpo) and intravenous iron were involved. Methods: Several parameters related to oxidative stress were assessed by spectrophotometry in stable HD patients, treated for at least 2 months with epoietinum (n = 14; mean dose = 97.7 ± 19.1 U/kg/week) or not (n = 15), none of them on iron therapy, and in 13 controls. Plasma thiobarbituric acid-reactive substances (TBARS) were used as markers of reactive species generation. Erythrocyte and plasma antioxidant systems, reflected by non-protein erythrocyte thiols, and erythrocyte enzyme activities – superoxide dismutase (SOD), glutathione peroxidase, catalase and plasma total thiols, respectively – were also investigated. Results: There were no differences between HD subgroups regarding haemoglobin levels. Plasma TBARS was increased in all HD patients as opposed to controls, irrespective of rHuEpo therapy. In addition, no change in antioxidant status parameters between rHuEpo-treated and -untreated patients was observed. Except for SOD, the other antioxidant indices were higher in all HD patients versus controls. Conclusions: These results suggest that (1) chronic HD patients appear to have simultaneously enhanced reactive species generation and antioxidative systems efficiency, and (2) epoietinum therapy did not change their oxidative status, at least in the absence of concomitant iron supplementation and at similar haemoglobin levels.

Oxidative stress in hemodialysis: Causative mechanisms, clinical implications, and possible therapeutic interventions

“…Many authors have reported that erythropoietin stimulating agents (ESAs) reduce OS in HD patients . In contrast, one study found that ESA treatment in maintenance HD patients failed to show any antioxidant effect despite anemia correction …”

“…48,[52][53][54] In contrast, one study found that ESA treatment in maintenance HD patients failed to show any antioxidant effect despite anemia correction. 55 Anemia management in HD patients usually includes treatment with iron supplementation. Intravenous (iv) infusion of iron sucrose appears to aggravate OS in CKD and HD patients.…”

The relationship between glutathione peroxidase and bioimpedance parameters in nondiabetic hemodialysis patients

“…Oxidative stress has historically been defined as an imbalance between oxidant production and antioxidant defense . Hemodialysis (HD) patients have a higher oxidative state, which results in the reduction of total antioxidant capacity and increased inflammation . HD patients experience numerous complications such as atherosclerosis and malnutrition, which may partly result from excess reactive oxygen species and/or decreased antioxidant activity .…”

“…1,2 Hemodialysis (HD) patients have a higher oxidative state, which results in the reduction of total antioxidant capacity and increased inflammation. [3][4][5][6] HD patients experience numerous complications such as atherosclerosis and malnutrition, which may partly result from excess reactive oxygen species and/or decreased antioxidant activity. [7][8][9][10][11][12][13] There is growing evidence from experimental and clinical studies that oxidative stress may be involved in the pathogenesis of malnutrition.…”

Взаємозв'язок Між Дозою Тривалого Активатора Рецепторів Еритропоетину Та Оксидативним Стресом У Хворих, Які Лікуються Методом Гемодіалізу

“…Several clinical reports have demonstrated the positive impact of ESA on OS status in HD patients [7,8] while other scientists have found no antioxidant effects of ESA [9,10].…”