Oxidative Stress in Hemodialysis Patients: A Review of the Literature.
Oxidative Stress in Hemodialysis Patients: A Review of the Literature.
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DOI：
10.1155/2017/3081856
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发表时间：
2017
影响因子：
--
通讯作者：
Mertens PR
中科院分区：
文献类型：
--
作者：
Liakopoulos V;Roumeliotis S;Gorny X;Dounousi E;Mertens PR
血液透析（HD）患者全因死亡率和心血管事件的风险很高。除了传统的危险因素外，过度氧化应激（OS）和慢性炎症是加速动脉粥样硬化和死亡率升高的新的主要因素。OS被定义为抗氧化防御机制和氧化产物之间的不平衡，后者压倒前者。OS出现在慢性肾脏疾病（CKD）的早期阶段，随着肾功能衰竭的恶化而进展，并因HD过程本身而进一步加重。HD患者表现出过度的OS状态，由于过多毒素的保留，尿毒症的补贴，营养缺乏抗氧化剂和抗氧化剂的转换，肾脏替代治疗期间抗氧化剂的损失，以及白细胞活化导致氧化产物的积累。透析治疗的持续时间、铁输注、贫血、中心静脉导管的存在以及生物不相容的透析器是引发OS发生的几个因素。即使在CKD的早期阶段，补充抗氧化剂也可能起到全面的保护作用，以阻止肾功能的恶化和对抗全身炎症。不幸的是，当抗氧化剂被用于血液透析患者时，临床研究并没有得出明确的积极结果，这可能是由于他们的异质临床条件和潜在的风险概况。
Hemodialysis (HD) patients are at high risk for all-cause mortality and cardiovascular events. In addition to traditional risk factors, excessive oxidative stress (OS) and chronic inflammation emerge as novel and major contributors to accelerated atherosclerosis and elevated mortality. OS is defined as the imbalance between antioxidant defense mechanisms and oxidant products, the latter overwhelming the former. OS appears in early stages of chronic kidney disease (CKD), advances along with worsening of renal failure, and is further exacerbated by the HD process per se. HD patients manifest excessive OS status due to retention of a plethora of toxins, subsidized under uremia, nutrition lacking antioxidants and turn-over of antioxidants, loss of antioxidants during renal replacement therapy, and leukocyte activation that leads to accumulation of oxidative products. Duration of dialysis therapy, iron infusion, anemia, presence of central venous catheter, and bioincompatible dialyzers are several factors triggering the development of OS. Antioxidant supplementation may take an overall protective role, even at early stages of CKD, to halt the deterioration of kidney function and antagonize systemic inflammation. Unfortunately, clinical studies have not yielded unequivocal positive outcomes when antioxidants have been administered to hemodialysis patients, likely due to their heterogeneous clinical conditions and underlying risk profile.
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