Imbalance of oxidants and antioxidants in haemodialysis patients
Imbalance of oxidants and antioxidants in haemodialysis patients
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DOI：
10.1159/000014381
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发表时间：
1999-01-01
影响因子：
3
通讯作者：
Vaussenat, F
中科院分区：
文献类型：
--
作者：
Canaud, B;Cristol, JP;Vaussenat, F
在长期血液透析患者中观察到的透析相关病理(DRP)越来越多地被报道。在DRP表现中，心血管疾病是最常见的，是血液透析患者死亡的第一位原因。脂类代谢和氧化应激的改变被认为是可以通过最佳治疗预防或减少的主要危险因素。为了评估预防氧化损伤干预的理论基础，我们回顾了血液透析患者氧化前氧化和抗氧化机制失衡的隐含因素和可能的原因。这种失衡导致的氧化应激是增加应激标志物和增强对低密度脂蛋白氧化的易感性的原因。导致这种氧化状态的因素分为四组：(1)终末期肾病(ESRD)患者的尿毒症和共病状态；(2)透析过程中抗氧化物质的丢失；(3)透析系统的血液不相容；(4)辅助治疗。最近的研究表明，抗氧化剂状态可以调节细胞的功能，如活性氧(ROS)的产生、黏附分子的表达和/或细胞的增殖。预防方法，包括使用生物相容的膜、超纯透析液、外源性补充抗氧化剂维生素、体外清除ROS和氧化修饰物质，似乎非常适合减少长期透析患者的并发症。
Dialysis-related pathology (DRP) observed in long-term haemodialysis patients is increasingly reported. Among DRP manifestations, cardiovascular disease is the most frequent, being the first cause of mortality in haemodialysis patients. Alterations in lipid metabolism and oxidative stress are recognised as major risk factors that could be prevented or reduced by optimal therapy.In order to evaluate the rationale for preventive intervention against oxidative damage we review the factors that are implied and may be responsible for the imbalance between prooxidative and antioxidative mechanisms in haemodialysis patients. Oxidative stress resulting from this imbalance is responsible for increasing stress markers and enhancing susceptibility to LDL oxidation. Factors implied in this prooxidative state belong to four groups: (1) uremia and comorbid status of the end stage renal disease (ESRD) patient; (2) losses of anti oxidant substances via the dialysis; (3) haemoincompatibility of the dialysis system; (4) adjuvant therapy. Such prooxidant status could have further deleterious consequences since it has been recently shown that antioxidant status could modulate cell functions such as reactive oxygen species (ROS) production, adhesive molecule expression and/or cell proliferation.Preventive modalities, including use of biocompatible membrane, ultrapure dialysate, exogenous supplementation of antioxidant vitamins, extracorporeal removal of ROS and oxidatively-modified substances, would appear highly desirable to reduce complications of long-term dialysis patients.