THE EVALUATION OF THE EFFECT OF THE TREATMENTS ON OXIDATIVE STRESS AND INFLAMMATION IN PATIENTS RECEIVING DIFFERENT DIALYSIS MODALITIES
Öz
ABSTRACT
Aim: To evaluate the effects of different dialysis methods on oxidative stress and inflammation in patients with end-stage renal disease (ESRD) who are newly enrolled in a routine dialysis program.
Material and Methods: In this prospective study, 138 ESRD patients and 30 healthy volunteers were evaluated. Fifty-four of 73 hemodialysis (HD) patients and 51 of 65 periton dialysis (PD) patients completed the study. Other patients were excluded from the study. The levels of superoxide dismutase (SOD) and total antioxidant capacity (TAC) were measured to determine the oxidative stress status, and IL-6, IL-10, and F2 isoprostane levels were measured to determine the inflammation status, just before the start of dialysis treatment and at 6 months.
Results: At the beginning of the study, hs-CRP and IL-6 levels were significantly higher in the patient group compared to the control group (p<0.001, p<0.001, respectively), and IL-10 levels were significantly lower (p=0.008). The hs-CRP and IL-10 levels in the HD group were found to be similar at the beginning of the study and in the 6th month. On the other hand, IL-6 levels decreased significantly compared to baseline values at 6 months (p=0.016). In the PD group, no difference was observed in terms of hs-CRP and IL-10 levels at the beginning and the 6th month (p>0.05), but IL-6 levels were found to be decreased compared to baseline at the 6th month (p<0.001). When HD and PD patient groups were compared with each other, no difference was found between the groups in terms of hs-CRP and IL-10 levels in the 6th month of dialysis treatment. IL-6 levels were found to be significantly higher in the HD group (p<0.001). At the beginning of the study, the F2 isoprostane level was significantly higher in the patient group than the control group (p<0.001), whereas the SOD and TAC levels were significantly lower (p=0.001, p=0.024, respectively). In the HD group, the F2 isoprostane level was found to be significantly higher at 6 months compared to baseline (p=0.019). There was no significant change in SOD and TAC levels. There was no significant difference in F2 isoprostane and TAC levels at 6 months from baseline in the PD group, whereas SOD levels were found to be significantly lower (p=0.015).
Conclusion: The oxidative status found in ESRD patients increases with dialysis treatments. Oxidative stress increase is more prominent in HD patients. Therefore, we think that giving antioxidant treatment in patient groups undergoing dialysis treatment may benefit complications related to oxidative stress.
Anahtar Kelimeler
Kaynakça
- 1. Himmelfarb J, Hakim RM. Oxidative stres in üremia. Curr Opin Nephrol Hypertens 2003;12 Suppl 6:593-8.
- 2. Himmelfarb J. Linking oxidative stres and inflammation in kidney disease: which is the chicken and which is the egg? Semin Dial 2004;17:449-54.
- 3. Li PK, Ng JK, Mcintyre CW. Inflammation and Peritoneal Dialysis. Semin Nephrol. 2017 Jan;37(1):54-65
- 4. Roumeliotis S, Eleftheriadis T, Liakopoulos V. Is oxidative stress an issue in peritoneal dialysis? Semin Dial. 2019 Sep;32(5):463-466
- 5. Calò LA, Naso A, Carraro G, Wratten ML, Pagnin E, Bertipaglia L, et al. Effect of haemodiafiltration with online regeneration of ultrafiltrate on oxidative stress in dialysis patients. Nephrol Dial Transplant. 2007;22:1413–9.
- 6. Coombes JS, Fassett RG. Antioxidant therapy in hemodialysis patients: a systematic review. Kidney Int. 2012 Feb;81(3):233-46
- 7. Kamimura MA, Draibe SA, Dalboni MA, Cendoroglo M, Avesani CM, Manfredi SR,et al. Serum and cellular interleukin-6 in haemodialysis patients: relationship with energy expenditure. Nephrol Dial Transplant. 2007 Mar;22(3):839-44.
- 8. Borazan A, Üstün H, Üstündag Y, et al. The effects of peritoneal dialysis and hemodialysis on serum tumor necros factör- alpha, interleukin-6, interleukin- 10 and C-reactive protein levels. Mediators İnflamm 2004; 13 Suppl 3:201- 14.
- 9. Arici M, Walls J. End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int 2001;59:407-14.
- 10. Stenvinkel P, Heimbürger O, Paultre F, et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int. 1999;55 Suppl 5:1899-911.
- 11. Kato A, Odamaki M, Takita T, Maruyama Y, Kumagai H, Hishida A. Association between interleukin-6 and carotid atherosclerosis in hemodialysis patients. Kidney Int. 2002;61 Suppl 3:1143-52.
- 12. Memoli B, Minutolo R, Bisesti V, et al. Collaborative Study Group on SMC Membrane. Changes of serum albumin and C-reactive protein are related to changes of interleukin-6 release by peripheral blood mononuclear cells in hemodialysis patients treated with different membranes. Am J Kidney Dis. 2002;39 Suppl 2:266-73.
- 13. Pecoits-Filho R, Bárány P, Lindholm B, Heimbürger O, Stenvinkel P. Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant. 2002;17 Suppl 9:1684-8.
- 14. Zhang W, He J, Zhang F, Huang C, Wu Y, Han Y, et al. Prognostic role of C-reactive protein and interleukin-6 in dialysis patients: a systematic review and meta-analysis. J Nephrol. 2013;26:243-53.
- 15. Oberg BP, McMenamin E, Lucas FL, et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int. 2004;65 Suppl 3:1009-16.
- 16. Sundl I, Roob JM, Meinitzer A, et al. Antioxidant status of patients on peritoneal dialysis: associations with inflammation and glycoxidative stress. Perit Dial Int. 2009;29 Suppl 1:89-101.
- 17. Danielski M, Ikizler TA, McMonagle E, et al. Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy. Am J Kidney Dis. 2003;42:286-94.
- 18. Kim HW, Woo YS, Yang HN, et al. Primed monocytes: putative culprits of chronic low-grade inflammation and impaired innate immune responses in patients on hemodialysis. Clin Exp Nephrol. 2011;15 Suppl 2:258-63.
- 19. Hasselwander O, Young IS. Oxidative stres in chronic renal failure. Free Radic Res 1998;29:1-11.
- 20. Mekki K, Taleb W, Bouzidi N, et al. Effect of hemodialysis and peritoneal dialysis on redox status in chronic renal failure patients: a comparative study. Lipids Health Dis. 2010;9:93.
- 21. Puchades Montesa MJ, González Rico MA, Solís Salguero MA, et al. Study of oxidative stress in advanced kidney disease. Nefrologia. 2009;29 Suppl 5:464-73.
- 22. Liakopoulos V, Roumeliotis S, Gorny X, Eleftheriadis T, Mertens PR. Oxidative stress in patients undergoing peritoneal dialysis: a current review of the literature. Oxid Med Cell Longev. 2017;2017:3494867
FARKLI DİYALİZ YÖNTEMLERİ ALAN HASTALARDA TEDAVİLERİN OKSİDATİF STRES VE İNFLAMASYON ÜZERİNDEKİ ETKİSİNİN DEĞERLENDİRİLMESİ
Öz
Öz
Amaç: Rutin diyaliz programına yeni başlayan son dönem böbrek yetmezliği (ESRD) olan hastalarda farklı diyaliz yöntemlerinin oksidatif stres ve inflamasyon üzerine etkilerini değerlendirmek.
Gereç ve Yöntemler: Bu prospektif çalışmada 138 SDBY hastası ve 30 sağlıklı gönüllü değerlendirildi. 73 hemodiyaliz (HD) hastasının 54'ü ve 65 periton diyalizi (PD) hastasının 51'i çalışmayı tamamladı. Diğer hastalar çalışma dışı bırakıldı. Oksidatif stres durumunu belirlemek için süperoksit dismutaz (SOD) ve toplam antioksidan kapasite (TAC) seviyeleri, inflamasyon durumunu belirlemek için IL-6, IL-10 ve F2 izoprostan seviyeleri, diyaliz tedavisi başlamadan hemen önce ölçüldü ve 6. ayda ölçüldü.
Bulgular: Çalışmanın başında hasta grubunda kontrol grubuna göre hs-CRP ve IL-6 düzeyleri anlamlı olarak yüksek (sırasıyla p<0.001, p<0.001), IL-10 düzeyleri anlamlı olarak düşüktü ( p=0.008). HD grubunda hs-CRP ve IL-10 düzeyleri çalışmanın başında ve 6. ayda benzer bulundu. IL-6 seviyeleri ise 6. ayda başlangıç değerlerine göre anlamlı olarak azaldı (p=0.016). PH grubunda başlangıç ve 6. ay hs-CRP ve IL-10 düzeyleri açısından fark izlenmezken (p>0,05), ancak 6. ayda IL-6 düzeylerinin başlangıca göre düştüğü saptandı. (p<0.001). HD ve PH hasta grupları kendi aralarında karşılaştırıldığında diyaliz tedavisinin 6. ayında hs-CRP ve IL-10 düzeyleri açısından gruplar arasında fark saptanmadı. IL-6 düzeyleri HD grubunda anlamlı olarak yüksek bulundu (p<0.001). Çalışmanın başında F2 izoprostan düzeyi hasta grubunda kontrol grubuna göre anlamlı olarak yüksek (p<0,001), SOD ve TAC düzeyleri anlamlı olarak düşüktü (sırasıyla, p=0,001, p=0,024). HD grubunda 6. ayda F2 izoprostan düzeyi başlangıca göre anlamlı olarak yüksek bulundu (p=0.019). SOD ve TAC düzeylerinde anlamlı bir değişiklik olmadı. PH grubunda 6. ayda F2 izoprostan ve TAC düzeylerinde başlangıca göre anlamlı fark bulunmazken, SOD düzeyleri anlamlı olarak düşük bulundu (p=0.015).
Sonuç: SDBY hastalarında bulunan oksidatif durum diyaliz tedavileri ile artmaktadır. Oksidatif stres artışı HD hastalarında daha belirgindir. Bu nedenle diyaliz tedavisi gören hasta gruplarında antioksidan tedavi verilmesinin oksidatif strese bağlı komplikasyonlara fayda sağlayabileceğini düşünüyoruz.
Anahtar Kelimeler
Kaynakça
- 1. Himmelfarb J, Hakim RM. Oxidative stres in üremia. Curr Opin Nephrol Hypertens 2003;12 Suppl 6:593-8.
- 2. Himmelfarb J. Linking oxidative stres and inflammation in kidney disease: which is the chicken and which is the egg? Semin Dial 2004;17:449-54.
- 3. Li PK, Ng JK, Mcintyre CW. Inflammation and Peritoneal Dialysis. Semin Nephrol. 2017 Jan;37(1):54-65
- 4. Roumeliotis S, Eleftheriadis T, Liakopoulos V. Is oxidative stress an issue in peritoneal dialysis? Semin Dial. 2019 Sep;32(5):463-466
- 5. Calò LA, Naso A, Carraro G, Wratten ML, Pagnin E, Bertipaglia L, et al. Effect of haemodiafiltration with online regeneration of ultrafiltrate on oxidative stress in dialysis patients. Nephrol Dial Transplant. 2007;22:1413–9.
- 6. Coombes JS, Fassett RG. Antioxidant therapy in hemodialysis patients: a systematic review. Kidney Int. 2012 Feb;81(3):233-46
- 7. Kamimura MA, Draibe SA, Dalboni MA, Cendoroglo M, Avesani CM, Manfredi SR,et al. Serum and cellular interleukin-6 in haemodialysis patients: relationship with energy expenditure. Nephrol Dial Transplant. 2007 Mar;22(3):839-44.
- 8. Borazan A, Üstün H, Üstündag Y, et al. The effects of peritoneal dialysis and hemodialysis on serum tumor necros factör- alpha, interleukin-6, interleukin- 10 and C-reactive protein levels. Mediators İnflamm 2004; 13 Suppl 3:201- 14.
- 9. Arici M, Walls J. End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int 2001;59:407-14.
- 10. Stenvinkel P, Heimbürger O, Paultre F, et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int. 1999;55 Suppl 5:1899-911.
- 11. Kato A, Odamaki M, Takita T, Maruyama Y, Kumagai H, Hishida A. Association between interleukin-6 and carotid atherosclerosis in hemodialysis patients. Kidney Int. 2002;61 Suppl 3:1143-52.
- 12. Memoli B, Minutolo R, Bisesti V, et al. Collaborative Study Group on SMC Membrane. Changes of serum albumin and C-reactive protein are related to changes of interleukin-6 release by peripheral blood mononuclear cells in hemodialysis patients treated with different membranes. Am J Kidney Dis. 2002;39 Suppl 2:266-73.
- 13. Pecoits-Filho R, Bárány P, Lindholm B, Heimbürger O, Stenvinkel P. Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant. 2002;17 Suppl 9:1684-8.
- 14. Zhang W, He J, Zhang F, Huang C, Wu Y, Han Y, et al. Prognostic role of C-reactive protein and interleukin-6 in dialysis patients: a systematic review and meta-analysis. J Nephrol. 2013;26:243-53.
- 15. Oberg BP, McMenamin E, Lucas FL, et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int. 2004;65 Suppl 3:1009-16.
- 16. Sundl I, Roob JM, Meinitzer A, et al. Antioxidant status of patients on peritoneal dialysis: associations with inflammation and glycoxidative stress. Perit Dial Int. 2009;29 Suppl 1:89-101.
- 17. Danielski M, Ikizler TA, McMonagle E, et al. Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy. Am J Kidney Dis. 2003;42:286-94.
- 18. Kim HW, Woo YS, Yang HN, et al. Primed monocytes: putative culprits of chronic low-grade inflammation and impaired innate immune responses in patients on hemodialysis. Clin Exp Nephrol. 2011;15 Suppl 2:258-63.
- 19. Hasselwander O, Young IS. Oxidative stres in chronic renal failure. Free Radic Res 1998;29:1-11.
- 20. Mekki K, Taleb W, Bouzidi N, et al. Effect of hemodialysis and peritoneal dialysis on redox status in chronic renal failure patients: a comparative study. Lipids Health Dis. 2010;9:93.
- 21. Puchades Montesa MJ, González Rico MA, Solís Salguero MA, et al. Study of oxidative stress in advanced kidney disease. Nefrologia. 2009;29 Suppl 5:464-73.
- 22. Liakopoulos V, Roumeliotis S, Gorny X, Eleftheriadis T, Mertens PR. Oxidative stress in patients undergoing peritoneal dialysis: a current review of the literature. Oxid Med Cell Longev. 2017;2017:3494867
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Temmuz 2023 |
| Kabul Tarihi | 23 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 13 Sayı: 4 |
