title: Comparative effects of silymarin and vitamin E supplementation on oxidative stress markers, and hemoglobin levels among patients on hemodialysis.
abstract: BACKGROUND
  The incidence of accelerated atherosclerosis among patients on hemodialysis is very high and oxidative stress (OS) is a potentially major contributor to their morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate the effects of Silymarin and/or vitamin E on OS markers and hemoglobin levels in patients on hemodialysis.
  
  
  METHODS
  Eighty patients on hemodialysis were randomized into four groups: Group 1 received silymarin 140 mg 3 times daily; Group 2 received vitamin E 400 IU/day; Group 3 received silymarin 140 mg 3 times daily and vitamin E 400 IU/day; and Group 4 was the control. Samples were obtained at baseline and on day 21 for measurement of malondialdehyde (MDA), red blood cell (RBC) glutathione peroxidase (GPX), and hemoglobin.
  
  
  RESULTS
  Combination of silymarin and vitamin E led to a reduction in the MDA levels (7.84 ± 1.84 vs. 9.20 ± 2.74 nmol/mL; p = 0.008). There was a significant increase in RBC GPX levels in all treatment groups compared with controls after 3 weeks. This was more pronounced in the group receiving combination compared with the group receiving vitamin E or the control group (5.78 ± 3.51, 4.22 ± 1.63, and 3.16 ± 1.89 IU/grHb, respectively; p < 0.001). There was also a significant increase in mean hemoglobin of all treatment groups compared with the control.
  
  
  CONCLUSIONS
  Oral supplementation with silymarin and vitamin E leads to reduction in MDA, increase in RBC GPX, and increase in hemoglobin levels in patients with end-stage renal disease. Studies with larger sample sizes and longer follow-up are required to investigate the effect of silymarin on cardiovascular outcomes and erythropoietin requirement.
authors.affiliation: Division of Nephrology, Department of Medicine, Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.
authors.forename: Jamshid
authors.initials: J
authors.lastname: Roozbeh
authors.forename: Bahram
authors.initials: B
authors.lastname: Shahriyari
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Akmali
authors.forename: Ghazal
authors.initials: G
authors.lastname: Vessal
authors.forename: Maryam
authors.initials: M
authors.lastname: Pakfetrat
authors.forename: Ghanbar Ali
authors.initials: GA
authors.lastname: Raees Jalali
authors.forename: Raha
authors.initials: R
authors.lastname: Afshariani
authors.forename: Mahshid
authors.initials: M
authors.lastname: Hasheminasab
authors.forename: Nasrollah
authors.initials: N
authors.lastname: Ghahramani
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000517:prevention & control; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D005260:Female; D005979:Glutathione Peroxidase / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects*; D012838:Silymarin / Q000627:therapeutic use*; D014810:Vitamin E / Q000627:therapeutic use*
chemical_list: D000975:Antioxidants; D006454:Hemoglobins; D012838:Silymarin; D014810:Vitamin E; D008315:Malondialdehyde; D005979:Glutathione Peroxidase