title: Effects of acetate-free citrate dialysate on glycoxidation and lipid peroxidation products in hemodialysis patients.
abstract: OBJECTIVE
  Previous studies have shown the presence of high levels of glycoxidation and lipid peroxidation products in association with atherosclerosis in patients with end-stage kidney disease. Acetates are commonly used buffer for correcting metabolic acidosis in hemodialysis (HD) patients. Since the toxic effects of acetates are well established, acetate-free citrate dialysate (AFD) has become available in Japan. The objective of the present study was to evaluate the suppressive effects of AFD on oxidative stress in maintenance HD patients by measuring plasma pentosidine and malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels as markers for glycoxidation and lipid peroxidation products.
  
  
  METHODS
  Plasma pentosidine, MDA-LDL and other laboratory parameters were examined on maintenance HD at the Juntendo University Hospital before and after switching to AFD.
  
  
  RESULTS
  MDA-LDL levels divided by LDL cholesterol were significantly lower than those before switching to AFD. Furthermore, levels of plasma pentosidine were lower than those before switching to AFD. Stepwise multiple regression analysis revealed that the percent change of the calcium-phosphorus product in the nondiabetic group and that of phosphorus in the diabetic group were predictive variables for the percent change of MDA-LDL/LDL, whereas the percent change of log high-sensitive C-reactive protein and that of systolic blood pressure in the nondiabetic group and that of diastolic blood pressure in the diabetic group were predictive variables for the percent change of plasma pentosidine.
  
  
  CONCLUSIONS
  It appears that AFD decreases glycoxidation and lipid peroxidation products when compared with acid citrate dextrose in HD patients. The reduction of oxidative stress by AFD during HD may have possible beneficial effects on atherosclerosis through calcium-phosphorus metabolism and blood pressure.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Atsumi
authors.initials: A
authors.lastname: Masuda
authors.forename: Shinji
authors.initials: S
authors.lastname: Hagiwara
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Tanimoto
authors.forename: Fumiko
authors.initials: F
authors.lastname: Kodama
authors.forename: Kozue
authors.initials: K
authors.lastname: Okumura
authors.forename: Nao
authors.initials: N
authors.lastname: Nohara
authors.forename: Mayumi
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Maiguma
authors.forename: Keisuke
authors.initials: K
authors.lastname: Omote
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Io
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurusu
authors.forename: Isao
authors.initials: I
authors.lastname: Ohsawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Chieko
authors.initials: C
authors.lastname: Hamada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Horikoshi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomino
keywords: Acetate-free dialysate; Atherosclerosis; Hemodialysis; Malondialdehyde-modified low-density lipoprotein; Pentosidine