title: Effects of vitamin C infusion and vitamin E-coated membrane on hemodialysis-induced oxidative stress.
abstract: Chronic hemodialysis (HD) patients manifest anemia and atherosclerosis with associated oxidative stress. We explored whether intravenous infusion of vitamin C (VC) and/or use of vitamin E (VE)-coated dialysis membrane could palliate HD-evoked oxidative stress. Eighty patients undergoing chronic HD were enrolled and randomly assigned into four groups: HD with intravenous VC (n=20), HD with VE-coated dialyzer (n=20), HD with both (n=20), and HD with neither (n=20). We evaluated oxidative stress in blood and plasma, erythrocyte methemoglobin/ferricyanide reductase (red blood cells (RBC)-MFR) activity, plasma methemoglobin, and pro-inflammatory cytokines in these patients. All patients showed marked increases (14-fold) in blood reactive oxygen species (ROS) after HD. The types of ROS were mostly hydrogen peroxide, and in lesser amounts, O2*- and HOCl. HD resulted in decreased plasma VC, total antioxidant status, and RBC-MFR activity and increased plasma and erythrocyte levels of phosphatidylcholine hydroperoxide (PCOOH) and methemoglobin. Intravenous VC significantly palliated HD-induced oxidative stress, plasma and RBC levels of PCOOH, and plasma methemoglobin levels and preserved RBC-MFR activity. The VE-coated dialyzer effectively prevented RBCs from oxidative stress, although it showed a partial effect on the reduction of total ROS activity in whole blood. In conclusion, intravenous VC plus a VE-coated dialyzer is effective in palliating HD-evoked oxidative stress, as indicated by hemolysis and lipid peroxidation, and by overexpression of proinflammation cytokines in HD patients. Using VE-coated dialyzer per se is, however, effective in reducing lipid peroxidation and oxidative damage to RBCs.
authors.affiliation: Taipei City Hospital, Heping Branch, and Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Yang
authors.forename: S-P
authors.initials: SP
authors.lastname: Hsu
authors.forename: M-S
authors.initials: MS
authors.lastname: Wu
authors.forename: S-M
authors.initials: SM
authors.lastname: Hsu
authors.forename: C-T
authors.initials: CT
authors.lastname: Chien
mesh_terms: D000975:Antioxidants / Q000032:analysis; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D016207:Cytokines / Q000097:blood / Q000502:physiology; D004921:Erythropoietin / Q000502:physiology; D005260:Female; D006461:Hemolysis; D006801:Humans; D006861:Hydrogen Peroxide / Q000097:blood; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015227:Lipid Peroxidation; D008297:Male; D008567:Membranes, Artificial; D008706:Methemoglobin / Q000032:analysis; D009247:NADH, NADPH Oxidoreductases / Q000097:blood; D010070:Oxalates / Q000097:blood; D018384:Oxidative Stress / Q000187:drug effects* / Q000502:physiology; D010713:Phosphatidylcholines / Q000097:blood; D017382:Reactive Oxygen Species / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D013054:Spectrophotometry, Atomic; D014810:Vitamin E / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*
chemical_list: D000975:Antioxidants; D016207:Cytokines; D008567:Membranes, Artificial; D010070:Oxalates; D010713:Phosphatidylcholines; D017382:Reactive Oxygen Species; C057590:phosphatidylcholine hydroperoxide; D004921:Erythropoietin; D014810:Vitamin E; D008706:Methemoglobin; D006861:Hydrogen Peroxide; D009247:NADH, NADPH Oxidoreductases; C014227:ferricyanide reductase; D001205:Ascorbic Acid