Oxidative stress and inflammation in hemodialysis patients

Dialysis is associated with an increased generation of oxidants, which play an important part in the development of endothelial dysfunction and athero genesis. Markers of oxidative stress include F2-isoprostanes and ethane. Me asurements in dialysis patients before dialysis showed higher levels of est erified plasma F2-isoprostanes (1.62 +/- 0.73 ng/mL) than in control subjec ts (0.27 +/- 0.10 ng/mL) (P < 0.001). Furthermore, levels also correlated w ith high plasma C-reactive protein (CRP) levels (r = .48, P = 0.015). Breat h ethane levels for dialysis patients (N = 19) were 6.32 +/- 3.16 pmol/kg-m in, in contrast to 3.08 +/- 1.50 pmol/kg-min in control subjects (N = 11, P < 0.005). Analysis to investigate the relationship between CRP levels and outcome indicated that there was a significant difference in mortality rate over a 3-year period between patients with low and high CRP values (P < 0. 001). Patients with high CRP (> 16.8 mg/L) levels were more than twice as l ikely to die as patients with low CRP levels (relative risk [RR] = 2.16; 95 % confidence interval [CI], 1.50-3.09). CRP values were a significant predi ctor of mortality even after controlling for diabetes, albumin, ferritin, a nd age at commencement of dialysis. The FIR for CRP after adjustment was 1. 58 (95% Cl, 1.06-2.34, P = 0.024). There were no significant interactions b etween CRP and other predictors of mortality, indicating that high CRP leve ls have an additive effect on the mortality risk. These findings show that hemodialysis patients are exposed to both oxidative stress and inflammation . (C) 2001 by the National Kidney Foundation, Inc.