Alteration in Plasma Total Antioxidant Capacity, Cardiotoxic Lipid Peroxidation Product and C-Reactive Protein: A Possible Explantation for the Increased Cardiovascular Risk in Children on Hemodialysis

Journal of Clinical and Basic Cardiology 2008; 11 (1-4): 2-7

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Keywords: C-reactive protein,  hemodialysis,  high sensitivity,  lipid peroxidation product,  total antioxidant capacity

Background: Patients with end-stage renal disease undergoing hemodialysis (HD) are exposed to oxidative stress, which is associated with an impairment of antioxidant defense and an overproduction of oxidative stress markers. Oxidative stress plays a significant role in the development of inflammation in these patients. Objectives: The high incidence of cardiovascular diseases in HD patients is now well established and the involvement of oxidative stress has been hypothesized in these phenomena. This study focused on a comparison of plasma total antioxidant capacity (TAC) and lipid peroxidation product and evaluated the relationship between them and high-sensitivity C-reactive protein in patients on HD. Subjects and Methods: Plasma (TAC), lipid peroxidation products, malondialdehyde (MDA) as well as high-sensitivity C-reactive protein were determined in 30 patients on HD and in 20 normal controls (NC). Results: TAC and MDA levels were significantly higher in patients on HD than in the control subjects (p < 0.001). The hs-CRP values were also significantly higher in patients than in the NC (p < 0.001). The percentage of HD patients with CRP > 10 mg/l was 30 %. The concentrations of TAC and MDA were positively correlated with hs-CRP in HD patients (p < 0.08, r = 0.52 and p < 0.04, r = 0.75, respectively). There were independent associations between hs-CRP level in the serum of HD patients and TAC concentration, MDA value, cholesterol concentration, Hb concentration and adequacy of dialysis by multiple linear regression analysis. Conclusion: Our study demonstrates an increase in oxidative stress in children on HD and that the susceptibility to oxidative stress is strongly related to the levels of MDA produced in plasma which is strongly indicative of the inflammatory status in HD patients. These profound disturbances in oxidative stress markers may provide an explanation for the cardiovascular complications in these patients.