Modulation of oxidative stress and microinflammatory status by colloids in refractory dialytic hypotension.
BACKGROUND
Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis. Therapeutic albumin has powerful anti-oxidant and anti-inflammatory properties. We have recently shown that systematic colloid infusion during hemodialysis sessions improves hemodynamic parameters in most dialysis hypotension-prone patients unresponsive to usual of preventive measures.We postulated that frequent hypotensive episodes may lead to a noxious inflammatory response mediated by oxidative stress induced by ischemia-reperfusion. The aim of this study was therefore to analyze the effect of 20% albumin and 4% gelatin infusions on oxidative stress and microinflammatory status in hypotension-prone patients unresponsive to usual preventive measures.


METHODS
Prospective cross-over study (lasting 20 weeks) of routine infusion of 200 ml of 20% albumin versus 200 ml of 4% gelatin in 10 patients with refractory intradialytic hypotension. We analyzed the effect of 20% albumin and 4% gelatin on microinflammatory status, oxidative stress, serum nitrite and nitrate levels by analysis of variance.


RESULTS
A significant decrease in serum ceruloplasmin and serum C3 was observed during the albumin period (p < 0.05, repeated measure ANOVA). A significant decrease in serum hydrogen peroxide was seen during albumin and gelatin administration (p < 0.01, repeated measure ANOVA) and a very large decrease in serum lipid peroxides was observed during the albumin period only (p < 0.01, Friedman test). Serum lactoferrin, serum proinflammatory cytokines and serum nitrite and nitrate levels remained stable during the different periods of this pilot trial.


CONCLUSIONS
We conclude that the improvement in microinflammatory status observed during colloid infusion in hypotension-prone dialysis patients may be related to a decrease in ischemia-reperfusion of noble organs, together with a specific reduction in oxidative stress by albumin.


BACKGROUND
ISRCTN 20957055.
Service de Néphrologie et de Dialyse, Hôpital Privé Claude Galien, 20 route de Boussy, 91480 Quincy sous Sénart, France. rostotom@orange.fr
Guy
G
Rostoker
Mireille
M
Griuncelli
Christelle
C
Loridon
Thomas
T
Bourlet
Eric
E
Illouz
Abbes
A
Benmaadi
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D003102:Colloids / Q000008:administration & dosage; D016207:Cytokines / Q000276:immunology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control*; D007249:Inflammation / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects* / Q000276:immunology; D006435:Renal Dialysis / Q000009:adverse effects*; D012709:Serum Albumin / Q000008:administration & dosage*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003102:Colloids; D016207:Cytokines; D012709:Serum Albumin