Glutathione and riboflavin status in supplemented patients undergoing home nocturnal hemodialysis versus standard hemodialysis.
BACKGROUND
Patients on conventional hemodialysis (HD) have elevated markers of oxidative stress and chronic inflammation, which may contribute to a high prevalence of cardiovascular disease. Glutathione (GSH), an important intracellular antioxidant, requires cysteine as a rate-limiting amino acid for its synthesis and riboflavin for its regeneration.


OBJECTIVE
We aimed to examine whether erythrocyte GSH (eGSH) concentrations and riboflavin status are influenced by the increased dialysis dose provided to vitamin-supplemented patients receiving home nocturnal hemodialysis (HNHD) (6-8 hours/session, 5-7 nights/week) compared with patients on standard hemodialysis (SHD) (4 hours/session, 3 days/week).


METHODS
This was a cross-sectional comparative study involving 30 patients undergoing SHD or HNHD regimens and a group of 15 healthy control subjects (HC). We measured eGSH concentration by liquid chromatography-tandem mass spectrometry, riboflavin status by eGSH reductase activity coefficient (EGRAC) as well as plasma total cysteine (Cys) and total homocysteine (Hcy), vitamin C by high-performance liquid chromatography, and C-reactive protein (CRP) by standard method. Estimated dietary protein and energy intakes were determined by 3-day food records, and nutritional status was assessed by subjective global assessment (SGA).


RESULTS
There were no significant differences among groups in eGSH concentration, EGRAC, dietary protein intake, and SGA score. SHD patients had significantly higher plasma Cys (P < .001) and Hcy compared with HNHD and HC groups (P = .048). Vitamin C was significantly lower (P = .01) and CRP significantly higher (P = .048) in both HD groups compared with HC.


CONCLUSIONS
eGSH concentration appears to be unaffected by dialysis dose in well-nourished HD patients.
Kannampuzha
Jovil
J
The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Donnelly
Sandra M
SM
McFarlane
Philip A
PA
Chan
Christopher T
CT
House
James D
JD
Pencharz
Paul B
PB
Darling
Pauline B
PB
D000328:Adult; D001205:Ascorbic Acid / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D003545:Cysteine / Q000097:blood; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004912:Erythrocytes / Q000737:chemistry / Q000201:enzymology; D005260:Female; D005978:Glutathione / Q000097:blood*; D005980:Glutathione Reductase / Q000097:blood; D006437:Hemodialysis, Home; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis; D012256:Riboflavin / Q000097:blood*; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood
D004044:Dietary Proteins; D014815:Vitamins; D006710:Homocysteine; D002097:C-Reactive Protein; D005980:Glutathione Reductase; D005978:Glutathione; D003545:Cysteine; D001205:Ascorbic Acid; D012256:Riboflavin