Potential Role of Nutrient Intake and Malnutrition as Predictors of Uremic Oxidative Toxicity in Patients with End-Stage Renal Disease

Abstract

Oxidative stress is an important risk factor for cardiovascular disease and death in hemodialysis (HD) patients. However, whether biochemical and nutritional markers might be useful to stratify HD patients according to the risk of oxidative damage remains unclear. We investigated whether low-cost and easily available parameters such as the profile of nutrients intake, nutritional status, and antioxidant defenses can predict lipid and protein oxidation in HD patients. Forty-nine HD patients (women = 20, men = 29), ranging from 18 to 65 years of age (73.5%) were submitted to biochemical and nutritional analysis. At least 93.9% of HD patients had malnutrition. A patient's stratification according to nutritional risk was highly coherent with anthropometric parameters and nutrients intake, which were complementarily used as markers of malnutrition. Nutritional stratification was unable to reveal differences in the oxidative status. On the other hand, carbohydrate and zinc intake, serum zinc (Zn), glutathione peroxidase (GPx) activity, total antioxidant capacity (TAC), and nonprotein antioxidants (npAC) in serum were predictive markers of lipid (R2 = 0.588, P < 0.001) and protein (R2 = 0.581, P < 0.001) oxidation. Interestingly, GPx activity, TAC, and npAC exhibited good (>80% < 90%) or excellent (>90%) accuracy to estimate lipid oxidation (P ≤ 0.01). Regarding the prediction of protein oxidation, GPx activity and TAC presented regular accuracy (>70% < 80%), and Zn serum levels exhibited good sensitivity (P ≤ 0.01). Herein, we provided evidence that clinical characteristics relevant to predict different levels of lipid and protein oxidation in HD patients can be easily obtained, during routine hospital visits by means of the combined analyses of biochemical and nutritional parameters.

The Prevalence of Malnutrition in Patients having Chronic Kidney Disease at A Tertiary Care Center in Karachi Pakistan

“…This situation is dangerous as the production of toxins can lead to a high mortality rate in these patients as their renal function is already compromised. 22,23 When it comes to the anthropometric variables, we had a mean BMI of 27.6 ± 5.1 kg/m 2 , Triceps skin fold thickness was 18.2 ± 7.1 mm and a mean mid upper arm circumference of 23.2 ± 3.9 mm 2 , which is similar to other similar studies. 20 In the modification in the diet in renal disease (MDRD) studies, the benefits of a low protein diet were assessed in patients with CKD.…”

“…57.3% of the patients were being seen by a nephrologist for great then1 year, 31.4% were under the care for less than six months, and 14.1% were in care for less than one month. 22 In our study, we used the body mass index as a tool to determine malnutrition. The mean body mass index was found to be 45.65 ± 1.94 kg/m 2 .…”

“…This value is higher in comparison to other studies. [21][22][23][24][25][26][27][28] The SGA tool is well recognized and well researched. It is the only tool recommended by the AS-PEN board of directors, and a patient generated SGA is used widely in clinics.…”

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

“…However, Silva et al (2019) found no difference in markers of oxidative stress and antioxidant defenses in malnourished HD patients identified using global objective assessment compared to mild or well-nourished patients [ 95 ]. In contrast, accumulation of advanced glycation end products, a biomarker of oxidative stress measured using skin auto fluorescence, was significantly associated with markers of malnutrition in HD patients such as lower serum albumin, lower handgrip strength, and lower protein intake [ 96 ].…”

Redox biomarkers in dietary interventions and nutritional observation studies - From new insights to old problems

“…Concerning patients undergoing HD, Silva et al [ 15 ] found no statistically significant associations between nutritional status and OS status in HD patients while Epifano et al [ 16 ] found inverse associations between nutrient intake with antioxidant properties (Cu, Zn, Mn, vitamin C and ω-3, vitamin E) and plasma nitric oxide (NO) concentrations in HD patients.…”