Oxidative stress and cardiovascular disease in dialyzed patients.
OBJECTIVE
Oxidative damage has been suggested to play a key role in accelerated atherosclerosis and to be involved in cardiovascular disease (CVD) of dialyzed patients who are at risk of increased oxidative stress. The purpose of the present study was to examine the relationship between the severity of CVD and some markers of oxidative stress and antioxidant activity in our hemodialyzed (HD) and peritoneal dialysis (PD) patients.


METHODS
Plasma reactive oxygen metabolites, malondialdehyde and 4-hydroxynonenal (MDA-4HNE), thiols, alpha-tocopherol, and total antioxidant status (TAS) were measured in 55 HD and in 16 PD patients. CVD was considered as the result of variably combined cardiac, cerebral, and vascular pathologies which were scored and grouped in a single CVD index and analyzed with respect to the markers of the oxidative status. 16 normal subjects served as controls.


RESULTS
All patients showed evidence of increased oxidative stress which was more severe in HD than in PD patients and which was exacerbated by HD. When cardiac, cerebral, and vascular diseases were analyzed separately, plasma MDA-4HNE and TAS were significantly higher in more severely affected HD patients, but not in PD patients. In HD patients the CVD index was directly correlated with both MDA-4HNE and TAS (r = 0.42, p < 0.01; r = 0.39, p < 0.01) and inversely correlated with alpha-tocopherol (r = -0.32, p < 0.05). MDA-4HNE and TAS were directly correlated in HD patients and inversely correlated in control subjects.


CONCLUSIONS
Our data show that, in spite of increased antioxidant defense, there is a relationship between the degree of lipid peroxidation and the severity of CVD in HD patients. Moreover, these data underscore the utility of MDA-4HNE, alpha-tocopherol, and TAS in the evaluation of cardiovascular disease.
Usberti
Mario
M
Servizio di Nefrologia e Dialisi, Ospedale di Leno, Leno, Italia.
Gerardi
Gian Mario
GM
Gazzotti
Rosa Maria
RM
Benedini
Stefania
S
Archetti
Silvana
S
Sugherini
Lidia
L
Valentini
Melissa
M
Tira
Paola
P
Bufano
Giuseppe
G
Albertini
Alberto
A
Di Lorenzo
Diego
D
D000447:Aldehydes / Q000097:blood; D000975:Antioxidants / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D015227:Lipid Peroxidation / Q000502:physiology; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology*; D010530:Peritoneal Dialysis; D017382:Reactive Oxygen Species / Q000378:metabolism; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects*; D014810:Vitamin E / Q000097:blood
D000447:Aldehydes; D000975:Antioxidants; D017382:Reactive Oxygen Species; D014810:Vitamin E; D008315:Malondialdehyde; C027576:4-hydroxy-2-nonenal