Oxidative Stress in Patients Undergoing Peritoneal Dialysis: A Current Review of the Literature

Abstract

Peritoneal dialysis (PD) patients manifest excessive oxidative stress (OS) compared to the general population and predialysis chronic kidney disease patients, mainly due to the composition of the PD solution (high-glucose content, low pH, elevated osmolality, increased lactate concentration and glucose degradation products). However, PD could be considered a more biocompatible form of dialysis compared to hemodialysis (HD), since several studies showed that the latter results in an excess accumulation of oxidative products and loss of antioxidants. OS in PD is tightly linked with chronic inflammation, atherogenesis, peritoneal fibrosis, and loss of residual renal function. Although exogenous supplementation of antioxidants, such as vitamins E and C, N-acetylcysteine, and carotenoids, in some cases showed potential beneficial effects in PD patients, relevant recommendations have not been yet adopted in everyday clinical practice.

Mechanisms of Cardiovascular Disorders in Patients With Chronic Kidney Disease: A Process Related to Accelerated Senescence

“…Moreover, oxidative stress is considered a hallmark feature of CKD-associated CVDs and contributes to all-cause mortality in this patient population. Also, physiological stress on the body of CKD patients is increased in very early stages of the disease, progresses parallel to the deterioration of renal function and is further exacerbated in patients undergoing dialysis (Liakopoulos et al, 2017. In fact, ESRD patients on both hemodialysis (HD) and peritoneal dialysis (PD) manifest significantly enhanced oxidative stress compared with that of predialysis uremic patients (Liakopoulos et al, 2017.…”

“…In CKD patients, a pro-oxidative physiologic state leads to oxidative tissue damage (Cachofeiro et al, 2008;Puchades Montesa et al, 2009;Popolo et al, 2013). Indeed, oxidative stress and damage increase in later stages of CKD and become severe in ESRD patients undergoing HD and PD (Liakopoulos et al, 2017. Several oxidative stress parameters gradually increase when renal disease progresses ( Table 1), suggesting that a decline in renal function may have a direct effect on the worsening of oxidative stress (Dounousi et al, 2006;Khansari et al, 2009).…”

“…In HD patients, several factors, such as duration of dialysis, biocompatibility of dialyzer membrane and dialysate, intravenous iron administration, activation of leukocytes, retention of uremic toxins, or anemia, contribute to the development and accumulation of oxidative products. In addition, the composition of PD dialysate solutions (such as increased osmolarity, low pH, high-glucose content, and presence of lactate buffer) can trigger oxidative stress in PD patients (Liakopoulos et al, 2017Roumeliotis et al, 2019a). However, PD is considered to be more biocompatible than HD.…”

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

“…Oxidative stress is increased at the very early stages of CKD, is augmented in parallel to deterioration of renal function, and is further exacerbated by the hemodialysis (HD) process . It has also been shown that end‐stage renal disease (ESRD) patients on maintenance HD exhibit significantly enhanced OS compared to those on peritoneal dialysis (PD) …”

“…7 It has also been shown that end-stage renal disease (ESRD) patients on maintenance HD exhibit significantly enhanced OS compared to those on peritoneal dialysis (PD). 8 During the last two decades, OS has become the center of attention as a novel, nontraditional risk factor for inflammation, atherosclerosis, diabetes mellitus (DM), and CKD progression. 9 The heavy CV burden and the increased mortality risk of HD patients is at least partially explained by the severe OS status seen in these patients.…”