title: Oxidative stress and other risk factors for white matter lesions in chronic hemodialysis patients.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a risk factor for cardiovascular disease and promotes oxidative tress (OS), which has been implicated in the pathogenesis of white matter lesions (WML), a form of small-vessel cerebrovascular disease. The relationship between OS and WML in chronic hemodialysis (HD) patients has not yet been studied.
  
  
  METHODS
  We studied 67 chronic HD patients, aged 40 - 65 years (average 54 years) without known cerebrovascular disease. All patients underwent brain magnetic resonance imaging and subcortical and periventricular WML were evaluated using semiquantitative measures. Patients were classified into two groups depending on the presence or absence of WML (Fazekas classification), and the WML were scored. Carotid ultrasonography was also performed to evaluate the presence of carotid artery plaques and/or stenosis. Markers of protein and lipid oxidation (protein carbonyl and oxLDL antibodies), the glutathione system, enzymatic antioxidants (superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase) and total antioxidant capacity (ORAC) were measured. OS markers were compared to those of a group of 36 healthy subjects.
  
  
  RESULTS
  WML were present in 54% of the total population. Patients who had WML were older and had lower predialysis diastolic blood pressure than patients without WML. Other potential cardiovascular risk factors for WML, including obesity, hyperlipidemia, diabetes mellitus, presence of carotid artery plaques or stenosis, and duration and adequacy of HD were not related to the presence of WML. Compared to controls, HD patients had increased OS and decreased antioxidant capacity. However, OS did not differ between patients with WML and those without, and we found no association between OS markers and mean WML scores. After adjusting for several factors, only age and low predialysis diastolic blood pressure independently predicted an increased risk of WML.
  
  
  CONCLUSIONS
  Our results confirm that chronic HD patients have increased OS, but this is not related to the presence or severity of WML.
authors.forename: Mònica
authors.initials: M
authors.lastname: Muñoz-Cortés
authors.forename: Carme
authors.initials: C
authors.lastname: Cabré
authors.forename: Diasol
authors.initials: D
authors.lastname: Villa
authors.forename: Joan Pere
authors.initials: JP
authors.lastname: Vives
authors.forename: Mercedes
authors.initials: M
authors.lastname: Arruche
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Compte
authors.forename: Josep
authors.initials: J
authors.lastname: Aguilera
authors.forename: Manel
authors.initials: M
authors.lastname: Jariod
authors.forename: Marta
authors.initials: M
authors.lastname: Romeu
authors.forename: Montserrat
authors.initials: M
authors.lastname: Giralt
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Vea
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000097:blood / Q000209:etiology* / Q000473:pathology; D015227:Lipid Peroxidation; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018384:Oxidative Stress; D050050:Protein Carbonylation; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000975:Antioxidants; D015415:Biomarkers