Vitamin E alleviates the oxidative stress of erythropoietin in uremic children on hemodialysis.
The efficacy of combined therapy with recombinant human erythropoietin (rhEPO) and vitamin E versus rhEPO alone in the treatment of anemia was examined in children (n = 10, aged 15.2 +/- 3.2 years) on chronic hemodialysis at the restart of rhEPO therapy after a 4-week interval. The results confirmed that rhEPO induced oxidative stress of the red blood cells as observed during the first rhEPO therapy. Vitamin E (15 mg/kg per day per os) was introduced after 2 weeks of rhEPO monotherapy, when the signs of acute oxidative stress appeared. The level of oxidized glutathione (GSSG) increased from 8.9 +/- 3.1 to 26.7 +/- 5.7 nmol/g hemoglobin (Hb) by that time. After 2 weeks of simultaneous vitamin E treatment, there was a significant difference in GSSG values compared with rhEPO monotherapy (10.1 +/- 3.9 vs. 56.7 +/- 15.8 nmol/g Hb, P < 0.001). A considerable decrease was observed in the previously high ratio of GSSG/reduced glutathione (GSH), an indicator of oxidative stress, and the level of carboxyhemoglobin, indicating hemolysis. A significant increase in Hb and hematocrit (P < 0.01) was achieved within 2 weeks of starting the combined therapy, while similar results occurred only at the 8th and 5th weeks without vitamin E. Antioxidant vitamin E supplementation improved the therapeutic effect of rhEPO in patients with chronic renal failure on hemodialysis.
Németh
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I
Department of Pediatrics, Albert Szent-Györgyi Medical University, Szeged, Hungary. Nemethil@pedia.szote.u-szeged.hu
Túri
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S
Haszon
I
I
Bereczki
C
C
D000293:Adolescent; D000975:Antioxidants / Q000627:therapeutic use*; D002248:Carbon Monoxide / Q000097:blood; D002648:Child; D004921:Erythropoietin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005978:Glutathione / Q000378:metabolism; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D008297:Male; D010084:Oxidation-Reduction; D018384:Oxidative Stress / Q000187:drug effects*; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects*; D013997:Time Factors; D014511:Uremia / Q000150:complications* / Q000628:therapy; D014810:Vitamin E / Q000627:therapeutic use*
D000975:Antioxidants; D006454:Hemoglobins; D058085:Iron Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin; D014810:Vitamin E; D002248:Carbon Monoxide; D005978:Glutathione