Molecular biology-based assessment of vitamin E-coated dialyzer effects on oxidative stress, inflammation, and vascular remodeling. Vitamin E‐‐Bonded Cellulose Membrane, Lipoperoxidation, and Anemia in Hemodialysis Patients Evaluation of a Novel Vitamin E Coated Cellulosic Membrane Hollow Fiber Dialyzer Vitamin E-coated polysulfone membrane improved red blood cell antioxidant status in hemodialysis patients. Comparative evaluation of oxidative and antioxidative capacity during high-flux hemodialysis using two different membranes. The effects of 1-year treatment with a haemodiafiltration with on-line regeneration of ultrafiltrate (HFR) dialysis on biomarkers of oxidative stress in patients with chronic renal failure Oxidative stress and erythrocyte integrity in end-stage renal failure patients hemodialysed using a vitamin E-modified membrane. Effects of vitamin C infusion and vitamin E-coated membrane on hemodialysis-induced oxidative stress. Effect of dialysis flux and membrane material on dyslipidaemia and inflammation in haemodialysis patients. The effect of a membrane dialyzer during hemodialysis on the antioxidant status and lipid peroxidation of patients with end-stage renal disease. Effects of vitamin E-coated membrane dialyser on markers of oxidative stress and inflammation in patients on chronic haemodialysis. Vitamin E-coated dialyzer reduces oxidative stress in hemodialysis patients. Effects of a vitamin E-modified dialysis membrane and vitamin C infusion on oxidative stress in hemodialysis patients. Evaluation of oxidant stress in chronic hemodialysis patients: use of different parameters. Effect of haemodiafiltration with online regeneration of ultrafiltrate on oxidative stress in dialysis patients. The effect of high-flux hemodialysis on hemoglobin concentrations in patients with CKD: results of the MINOXIS study. Decreased oxidative stress in patients with ulcerative colitis supplemented with fish oil omega-3 fatty acids.
Cardiovascular disease represents the most common cause for the excess of morbidity and mortality found in end-stage renal disease ( ESRD ) and has prompted the exploration of multiple approaches to improve outcomes in these patients . Cardiovascular risk factors such as increased oxidative stress ( OxSt ) and inflammation are found in ESRD patients . A vitamin E-coated dialyzer using polysulfone membranes has been suggested to have positive effects on these factors . This 1-year study evaluated in 25 ESRD patients under chronic dialysis , the effects of a vitamin E-coated membrane ( VitabranE ViE ) " ex vivo " on mononuclear cells , OxSt , and inflammation-related biochemical and molecular biology markers using a molecular biology approach . p22(phox ) , heme oxygenase (HO)-1 , plasminogen activator inhibitor (PAI)-1 protein level , and phosphorylated extracellular signal-regulated kinase (pERK)1/2 status were evaluated at the beginning of the study , after 6 months and after 12 months by Western blot analysis and oxidized low-density lipoprotein ( OxLDL ) plasma level by enzyme-linked immunosorbent assay , alongside vascular remodeling assessment as measured by carotid intima-media thickness ( IMT ) in a subgroup of nine r and omly selected patients . p22(phox ) , PAI-1 , OxLDL , and pERK all decreased with VitabranE use , while HO-1 increased . Carotid IMT did not increase . Treatment with VitabranE significantly decreases the expression of proteins and markers relevant to OxSt and inflammation tightly associated with cardiovascular disease , and it appears highly likely that VitabranE use will provide a benefit in terms of cardiovascular protection In hemodialysis patients , oxidative stress results from an imbalance between the production of reactive oxygen species and antioxidant defense mechanisms . Recently , a new dialysis multi‐‐layer membrane has been developed , by modifying the inner surface of regenerated cellulose to support a vitamin E coating . The aim of our study was to investigate the effects of hemodialysis treatment with vitamin E‐‐modified membrane on anemia and erythropoietin requirement in a group of chronic uremic patients . Ten uremic , non diabetic , patients on st and ard bicarbonate dialysis were treated with vitamin E‐‐bonded dialysis membrane for 12 months . Hematological parameters , erythropoietin requirement , serum vitamin E and serum malonyldialdehyde ( ( MDA ) ) were evaluated before starting the study and monthly . No significant changes in hemoglobin level , RBC count , hematocrit and EPO requirement were observed . Basal vitamin E levels were in the normal range ( ( 13.0±2.88 mg//L vs. 14.79±3.12 mg//L ; NS ) ) . On the contrary , basal MDA levels were higher than those observed in the control group ( ( 1.87±0.36 vs. 1.13±0.18 mmol//mL ; p < 0.01 ) ) and a significant decrease of MDA levels was found after 1 month of Excebrane ® treatment ( ( 1.39±0.25 nmol//mL ; p < 0.02 ) ) . In conclusion , the role of the “ oxidative hemolysis ” in the pathogenesis of anemia in CHD patients is still not clearly defined , but it could be of minor clinical relevance . Although the effectiveness of vitamin E‐‐coated membranes as a scavenger of ROS allows a better control of intradialytic oxidative stress , it does n't seem to contribute to clinical management of anemia in these patients Adverse physiologic effects accompany hemodialysis . Biocompatible dialyzer membranes may both limit oxidative stress and decrease & bgr;2-microglobulin production , thereby reducing patient morbidity . We compared st and ard solute clearance , lipid , and antioxidant effects of a novel cellulosic membrane dialyzer modified with covalently bonded vitamin E ( Excebrane Clirans E15 , Terumo Australia ) with st and ard cellulosic and polysulphone membrane dialyzers .  Stable adult hemodialysis patients taking no lipid lowering or antioxidant therapy ( n = 17 ; 9 male , 8 female ) were recruited into a 10 week , prospect i ve , unblinded study . Measurements were made at baseline on their usual dialyzer and after 2 , 4 , and 10 weeks of Excebrane use . Excebrane demonstrated good in vivo clearance of st and ard solutes relative to surface area . Predialysis & bgr;2-microglobulin levels were unchanged with time and were significantly lower postdialysis than with cellulose acetate ( p < 0.05 ) . Oxidized low density lipoprotein levels as measured by nitrotyrosine residues were high predialysis , but tended to decrease with both membranes ( p > 0.05 ) . Total antioxidant status fell during dialysis ( p < 0.0005 ) , but plasma vitamin A and E concentrations increased ( p = 0.007 and p = 0.02 , respectively ) . Baseline vitamin A levels were high in all patients and , along with vitamin E , total antioxidant status and lipid profiles did not change over time with Excebrane use . Excebrane is an efficient , biocompatible membrane with no deleterious effects on & bgr;2-microglobulin or lipids . More long-term study is merited BACKGROUND Oxidative stress has emerged as a strong pathogenic cofactor implicated in the development of long-term complications in hemodialysis ( HD ) patients , such as anemia , and as a major component of the malnutrition inflammation complex syndrome . This prospect i ve multicenter study aim ed at evaluating the short-term effects of the new vitamin E (vitE)-coated polysulfone ( PS ) membrane ( VitabranE ) on biocompatibility performances and anemia in HD patients . METHODS After a 3-month washout period with a high-flux synthetic dialyzer , 43 HD patients were switched to a vitE-PS dialyzer .  Sampling was performed at baseline ( corresponding to the end of the washout period ) and after 1 , 2 and 3 months of treatment . Oxidative stress status , as well as inflammatory parameters , was investigated at the end of each study period . Hemoglobin levels and administered doses of recombinant human erythropoietin or epoetin ( EPO ) were available in each center . RESULTS The use of vitE-coated membranes for 3 months was not associated with any change in inflammatory parameters . By contrast , vitE-PS dialyzer result ed in a progressive increase in red blood cell ( RBC ) vitE concentration and in RBC superoxide dismutase activity . A concomitant progressive significant decrease in advanced oxidation protein product concentration at 2 months was observed , suggesting a preventive effect on oxidative stress . Finally , a significant decrease of the erythropoietin resistance index was obtained after 3 months of treatment . CONCLUSIONS Use of the vitE-PS membrane during a short period improves erythrocyte antioxidant defense mechanisms and seems to lead to a reduction in EPO requirements in HD patients AIM In patients with end-stage renal disease ( ESRD ) cardiovascular morbidity and mortality are increased . Apart from traditional and uremia-specific factors oxidative stress has been implicated as a main risk factor . This study investigated the influence of two different high-flux hemodialysis membranes on parameters of oxidative stress during a dialysis session . PATIENTS AND METHODS 14 stable ESRD patients were enrolled in the study and r and omly assigned to high-flux hemodialysis using either a polyamide membrane ( Polyflux 14 ; PA group ) or a new polysulfone membrane ( Diacap Polysulfone HI PS 15 ; PS group ) . All patients received 6 treatments with the same membrane . During the 5th treatment parameters of dialysis efficiency , biocompatibility ( cell counts , complement C3a , thrombin-antithrombin complex ) and oxidative stress ( lipid peroxides , total antioxidative capacity ) were measured . RESULTS Parameters of dialysis efficiency and biocompatibility were similar in both treatment groups . At the beginning of the dialysis session both groups showed a low to moderate level of oxidative stress and a reduced total antioxidative capacity as compared to healthy controls . Both parameters deteriorated significantly during the extracorporeal procedure with a similar magnitude in both membrane groups . No correlation between oxidative or antioxidative capacity and parameters of biocompatibility or dialysis efficiency could be found . CONCLUSIONS Dialysis with synthetic high-flux membranes induces a temporary deterioration of oxidative stress parameters in ESRD patients despite good dialysis efficiency and biocompatibility In the last few years haemodiafiltration with on-line regeneration of ultrafiltrate ( HFR ) has been shown to have a positive impact on inflammation and oxidative stress biomarkers , but its effect on antioxidant levels and on oxidative damage to biomolecules in the long-term is still unknown . This is a r and omised clinical study over 12 months involving 40 patients on haemodialysis , comparing the effect of HFR ( n = 25 ) dialysis with haemodialysis with polysulfone ( HD-PS , n = 15 ) on oxidative stress . Total antioxidant capacity , enzymatic antioxidant [ superoxide dismutase ( SOD ) , catalase and glutathione peroxidase ] , non-enzymatic ( GSH ) and biomarkers of oxidative stress ( TBARs , carbonyl groups and 8-OH-dG ) were evaluated . The antioxidant activity decreased in the lymphocytes of patients dialysed with HFR , with a significant decrease in the enzyme SOD . In the oxidative stress biomarkers , an increase was seen in the levels of 8-OH-dG in patients on HD-PS dialysis but not in those treated with HFR . Throughout the year the changes in antioxidant levels and biomarkers of oxidative damage in patients dialysed with HFR were generally more modest and fluctuated less than those dialysed with HD-PS . Our study indicates that , in general , long-term dialysis with HFR does not modified antioxidant parameters or increases the oxidative damage to biomolecules . The HFR showed to be a biocompatible technique for long-term dialysis Oxidative stress has been implicated in a range of disease states , including end-stage renal failure treated with hemodialysis . Hemodialysis with vitamin E-modified membranes reduces lipid peroxidation , but the effect on erythrocyte integrity has not been determined . This study compared antioxidant defense parameters and the resistance of erythrocytes to free radical-mediated hemolysis in patients dialysed with cellulose acetate membranes at baseline and with a vitamin E-modified membrane ( Excebrane Clirans ; Terumo Corporation ) for 13 wk .  Resistance of erythrocytes to free radical attack was assessed in vitro using the peroxyl hemolysis test . The time to 50 % hemolysis ( T50 % ) increased significantly during the first 6 wk of Excebrane use ( p < 0.05 ) , but this parameter returned to baseline by 13 wk . Glutathione concentration and erythrocyte superoxide dismutase activity were unchanged during the study , but glutathione peroxidase activity increased from low levels at baseline and became significantly higher at 6 and 13 wk ( p < 0.001 ) . Total erythrocyte polyunsaturated fatty acid content and C18:2 level increased ( p < 0.001 ) and saturated fatty acids ( total , C16:0 , C18:0 , C22:0 and C24:0 ) decreased ( p < 0.03 ) . Total monounsaturated fatty acid content was unchanged . The increased resistance of erythrocytes to hemolysis , the increased glutathione peroxidase activity , and the increased degree of unsaturation of fatty acids in the erythrocyte membrane are compatible with a reduction of oxidative stress during hemodialysis with vitamin E-modified membranes Chronic hemodialysis ( HD ) patients manifest anemia and atherosclerosis with associated oxidative stress . We explored whether intravenous infusion of vitamin C ( VC ) and /or use of vitamin E (VE)-coated dialysis membrane could palliate HD-evoked oxidative stress . Eighty patients undergoing chronic HD were enrolled and r and omly assigned into four groups : HD with intravenous VC ( n=20 ) , HD with VE-coated dialyzer ( n=20 ) , HD with both ( n=20 ) , and HD with neither ( n=20 ) . We evaluated oxidative stress in blood and plasma , erythrocyte methemoglobin/ferricyanide reductase ( red blood cells (RBC)-MFR ) activity , plasma methemoglobin , and pro-inflammatory cytokines in these patients . All patients showed marked increases ( 14-fold ) in blood reactive oxygen species ( ROS ) after HD . The types of ROS were mostly hydrogen peroxide , and in lesser amounts , O2 * - and HOCl . HD result ed in decreased plasma VC , total antioxidant status , and RBC-MFR activity and increased plasma and erythrocyte levels of phosphatidylcholine hydroperoxide ( PCOOH ) and methemoglobin . Intravenous VC significantly palliated HD-induced oxidative stress , plasma and RBC levels of PCOOH , and plasma methemoglobin levels and preserved RBC-MFR activity . The VE-coated dialyzer effectively prevented RBCs from oxidative stress , although it showed a partial effect on the reduction of total ROS activity in whole blood . In conclusion , intravenous VC plus a VE-coated dialyzer is effective in palliating HD-evoked oxidative stress , as indicated by hemolysis and lipid peroxidation , and by overexpression of proinflammation cytokines in HD patients . Using VE-coated dialyzer per se is , however , effective in reducing lipid peroxidation and oxidative damage to RBCs BACKGROUND Dyslipidaemia , inflammation and oxidative stress are prominent risk factors that potentially cause vascular disease in haemodialysis patients .  Dialysis modalities affect uraemic dyslipidaemia , possibly by modifying oxidative stress , but the effects of dialyser flux and membrane material on atherogenic remnant particles and oxidized low-density lipoproteins ( LDL ) are unknown . METHODS We performed a r and omized crossover study in 36 patients on haemodialysis  to analyse the effect of dialyser flux and membrane material on plasma lipids , apolipoproteins and markers of inflammation and oxidative stress . Stable patients on low-flux dialysis with polysulphone for > /=6 weeks were assigned to high-flux polysulphone or high-flux modified cellulose with similar dialyser surface area and permeability characteristics and crossed over twice every 6 weeks . RESULTS Thirty patients completed the study per protocol . Treatments with high-flux polysulphone and modified cellulose lowered serum triglyceride ( by 20 % and 10 % , respectively ; P<0.05 ) and remnant-like particle cholesterol by 32 % ( P<0.001 ) and 11 % ( NS ) after the first 6 weeks of treatment . Oxidized LDL decreased significantly with high-flux polysulphone , but not with modified cellulose . Apolipoproteins CII and CIII were reduced , whereas the ratio CII/CIII was increased ( all P<0.05 ) . Acute-phase proteins and LDL and high-density lipoprotein cholesterol remained unaffected . CONCLUSIONS This r and omized crossover study demonstrates a potent effect of high-flux haemodialysis on uraemic dyslipidaemia .  Polysulphone membrane material showed superiority on oxidatively modified LDL , an indicator of oxidative stress in haemodialysis patients Renal failure is accompanied by oxidative stress , which is caused by enhanced production of reactive oxygen species ( ROS ) and an impaired antioxidant defense . We studied 73 hemodialysis ( HD ) patients ( 39 males and 34 females ) aged 24 - 75 years ; the patients were r and omized into two subgroups according to the type of hemodialysis membrane  ( 35 patients were dialyzed on cellulose and 38 patients on polysulfone F7/F9 membrane dialyzers ) and we assessed their antioxidant and lipid peroxidation status levels . The total antioxidant status ( TAS ) levels including whole blood levels of malondialdehyde ( MDA ) and glutathione ( GSH ) ; glutathione peroxidase ( GSH-Px ) , superoxide dismutase ( SOD ) , and catalase ( CAT ) activities were measured , before and after hemodialysis . The MDA levels significantly increased 52.0 % and 16.9 % post dialysis among the cellulose and the polysulfone dialyzer users , respectively , ( P<0.05 ) . The TAS levels significantly decreased , 22.0 and 16.5 % in the cellulose and polysulfone dialyzer users , respectively , ( P<0.05 ) . The erythrocyte SOD activity decreased 25.1 and 19.1 % in the cellulose and the polysulfone dialyzer users , respectively , ( P<0.05 ) . The GSH concentrations , post dialysis , decreased 49.9 and 6.8 % in the cellulose and polysulfone dialyzer users , respectively , ( P<0.05 ) . In contrast , the erythrocyte activity of CAT , post dialysis , increased 15.0 and 37.3 % in the polysulfone and the cellulose dialyzer users , respectively , ( P<0.05 ) . We conclude that the type of the dialysis membrane affects the oxidative status after HD with possible consequences on patient morbidity and mortality BACKGROUND In the present prospect i ve , controlled , observational cohort study , we investigated the effects of the use of a vitamin E-coated membrane dialyser ( VEM ) on markers of chronic inflammation , oxidative stress and endothelial cell apoptosis in end-stage renal disease ( ESRD ) patients on chronic haemodialysis ( HD )  , as long as evidence of their effects on these pathogenetic routes are inconclusive as yet , despite their use for the last several years . METHODS Thirty-five stable ESRD patients underwent HD with the use of VEM for 6 months . Another 25 age- and sex-matched ESRD patients , being dialysed with conventional dialysers , served as controls . In both patient groups , beyond complete haematology and biochemistry work-up , serum CRP , apolipoproteins A1 and B , lipoprotein ( a ) ( Lp(a ) ) , hsIL-6 , MCP-1 , sICAM-1 , sVCAM-1 , sE-selectin , sFas and sFasL as well as plasma oxLDL , TBARS and TAS levels were determined at baseline and at 6 months of the study . RESULTS In the VEM group at 6 months , a significant reduction in CRP ( P = 0.004 ) , IL-6 ( P = 0.004 ) and sICAM-1 ( P = 0.04 ) levels was observed compared with baseline , along with a remarkable change in all markers of oxidative stress , i.e. increase in TAS ( P = 0.005 ) and decrease in TBARS ( P = 0.04 ) and oxLDL ( P < 0.001 ) . No significant changes were noted in the other parameters studied in the VEM group or in any parameter studied in the controls . Between the groups , significant differences were found in the change of CRP ( P = 0.001 ) , sICAM-1 ( P = 0.03 ) and oxLDL ( P = 0.04 ) compared with baseline . CONCLUSIONS HD with the use of VEM result ed in a significant reduction in inflammation and oxidative stress markers . Larger prospect i ve r and omized studies will need to confirm the findings of the present observational study The high incidence of cardiovascular disease in hemodialyzed ( HD ) patients is well established and oxidative stress has been involved in this phenomenon . The aim of our study was to evaluate if a vitamin E-coated dialyzer could offer protection to HD patients against oxidative stress . Sixteen HD patients were successively assessed for one month ( i ) on a high biocompatible synthetic dialyzer ( AN ) and ( ii ) on a vitamin E-coated dialyzer ( VE ) .  Blood sample s were taken before and after the dialysis session at the end of each treatment period . HD session conducted with the AN dialyzer was responsible for acute oxidative stress , significantly assessed after HD by a decreased plasma vitamin C level and an increased ascorbyl free radical (AFR)/vitamin C ratio used as an index of oxidative stress . Plasma elastase activity , reflecting neutrophil activation , was also increased ; soluble P-selectin , reflecting platelet activation , did not show any variation . The use of the VE dialyzer was associated with a less extended oxidative stress compared with the AN membrane : basal vitamin C level was higher , and after the HD session AFR/vitamin C ratio and elastase activity were not significantly increased . Plasma vitamin E levels were not affected . Our study demonstrates that HD is associated with oxidative stress , which can be partially prevented by the use of a vitamin E-coated dialyzer . Our data suggest that this dialyzer may exert a site-specific scavenging effect on free radical species in synergy with a reduced activation of neutrophils Hemodialysis deteriorates oxidative stress . Vitamin E is an antioxidant whose regeneration is provided for by vitamin C. The authors tested the effects of a vitamin E-modified membrane ( E ) , nonmodified cellulose membrane ( O ) , and vitamin C infusion ( 500 mg , C ) into the arterial blood line during dialysis on parameters of oxidative stress . In a short-term study , 24 patients were subjected to a single dialysis session  with E , O , E with C , and O with C protocol s. In a long-term study ( 12 weeks ) , 20 patients were r and omized into groups with C and without C on each dialysis , and both groups had dialysis using O , E , and again O membrane for 4 weeks each . In the short-term study , thiobarbituric acid reacting substances ( TBARS ) in plasma rose after dialysis ( p < 0.02 ) with O , and no changes were observed in the other 3 protocol s. In the long-term study , predialysis TBARS declined when using E both in the groups with C ( p < 0.02 ) and without C ( p < 0.05 ) . A switch over to O result ed in TBARS returning to baseline levels . The E membrane prevented an increase in lipid peroxidation during single dialysis , and long-term use of the E membrane also result ed in a decrease in the predialysis lipid peroxidation level . The antioxidant capacity of the E membrane was not enhanced by vitamin C infusion . High doses of vitamin C administered during dialysis using a nonmodified cellulose membrane prevented an increase in lipid peroxidation , most probably due to the enhanced rate of endogenous vitamin E regeneration Patients with chronic renal failure , particularly those undergoing regular dialysis treatment ( RDT ) are c and i date s for free radical damage . It is difficult to quantitate free radicals because of their short half-lives and reactive nature . Therefore , indirect methods measuring products of lipid peroxidation and protein oxidation are preferred . The present study displays a profile of lipid peroxidation and protein oxidation parameters , which are more sensitive and specific than the widely used method measuring thiobarbituric acid reactive substances ( TBARS ) , adapted to the plasma and erythrocyte sample s of RDT patients . We have observed increased levels of plasma and erythrocyte lipid peroxidation and also demonstrated increased protein oxidation in erythrocyte membranes of RDT patients BACKGROUND Increased oxidative stress ( OxSt ) as well as inflammation are risk factors for cardiovascular events and determinant of cardiovascular disease which remains the most common cause of excess morbidity and mortality for end-stage renal disease ESRD patients . Haemodiafiltration with on-line regeneration of ultrafiltrate ( HFR ) has been shown to have a positive impact on markers of inflammation while its effect on OxSt is not known . METHODS This study evaluates in haemodialysis patients the effect of HFR on the plasma level of oxidized LDL ( OxLDL ) , a marker of OxSt , and mononuclear cell gene and protein expression of OxSt-related proteins such as p22phox ( subunit of NAD(P)H oxidase ) , PAI-1 ( induced by OxSt and atherothrombogenetic ) and haeme-oxygenase-1 ( HO-1 ) ( induced by OxSt ) . Fourteen patients were r and omized into two groups in a crossover design , treated for 6 month periods with HFR ( SG8 Plus-Bellco , Mir and ola , Italy ) or low-flux bicarbonate dialysis ( HD ) using a polysulphone dialyser 1.8 m2 . Blood sample s were collected at the beginning of the study , after 6 months ( crossover ) and after 12 months . RESULTS ANOVA analysis of the data performed to rule out any crossover effect in either sequence was not significant and thus data from both sequences were combined and then analysed further statistically . HFR reduced mRNA production and protein expression of p22phox and PAI-1 compared with HD ( -9+/-5 vs 2+/-6 Delta% , P<0.0001 and -15+/-20 vs 3+/-17 Delta% , P<0.05 for p22phox ; -19+/-6 vs -5+/-5 Delta% , P<0.0001 and -24+/-12 vs 9+/-15 Delta% , P<0.0001 for PAI-1 ) . HO-1 was unchanged ( -12+/-8 vs -10+/-8 Delta% and -21+/-12 vs -14+/-8 Delta% ) while plasma OxLDL was reduced ( -14+/-19 vs 1+/-14 Delta% , P<0.01 ) . CONCLUSIONS The results of our study indicate that HFR treatment , compared with st and ard dialysis , has a lower impact on OxSt . Given , the strong relationship between OxSt and inflammation and their impact on the long-term cardiovascular complications in end-stage renal disease patients , HFR might have a more beneficial impact in reducing the risk of atherosclerotic cardiovascular disease in dialysis patients BACKGROUND AND OBJECTIVES Hemodialysis treatment induces markers of inflammation and oxidative stress , which could affect hemoglobin levels and the response to erythropoietin use . This study sought to determine whether high-flux dialysis would help improve markers of renal anemia , inflammation , and oxidative stress compared with low-flux dialysis . DESIGN , SETTING S , PARTICIPANTS , & MEASUREMENTS In a prospect i ve , controlled study , 221 patients undergoing maintenance hemodialysis and receiving darbepoetin-alfa treatment ( mean age , 66 years ; 55 % male ) from 19 centers were screened in a 20-week run-in period of low-flux hemodialysis with a synthetic dialysis membrane . Thereafter , 166 patients were enrolled and r and omly assigned to receive a synthetic high-flux membrane or to continue on low-flux dialysis for 52 weeks . Data on myeloperoxidase , oxidized LDL , high-sensitivity C-reactive protein , and the Malnutrition Inflammation Score were collected at baseline and after 52 weeks ; routine laboratory data , such as hemoglobin , ferritin , and albumin , and the use of darbepoetin-alfa , were also measured in the run-in period . Results After 52 weeks , the low-flux and the high-flux groups did not differ with respect to hemoglobin ( mean ± SD , 11.7±0.9 g/dl versus 11.7±1.1 g/dl ; P=0.62 ) or use of darbepoetin-alfa ( mean dosage ± SD , 29.8±24.8 μg/wk versus 26.0±31.1 μg/wk ; P=0.85 ) . Markers of inflammation , oxidative stress , or nutritional status also did not differ between groups . CONCLUSION Over 1 year , high-flux dialysis had no superior effects on hemoglobin levels or markers of inflammation , oxidative stress , and nutritional status . These data do not support the hypothesis that enhanced convective toxin removal would improve patient outcome OBJECTIVE The potential pathogenicity of free radicals may have a pivotal role in ulcerative colitis . Fish oil omega-3 fatty acids exert anti-inflammatory effects on patients with ulcerative colitis ( UC ) , but the precise mechanism of the action of fish oil on oxidative stress is still controversial . The aim of the present work was to verify the blood oxidative stress in patients with UC and determine whether the association of sulfasalazine to fish oil omega-3 fatty acids is more effective than isolated use of sulfasalazine to reduce the oxidative stress . METHODS Nine patients ( seven female and two male ; mean age = 40 + /- 11 y ) with mild or moderate active UC were studied in a r and omized crossover design . In addition to their usual medication ( 2 g/d of sulfasalazine ) , they received fish oil omega-3 fatty acids ( 4.5 g/d ) or placebo for 2-mo treatment periods that were separated by 2 mo , when they only received sulfasalazine .  Nine healthy individuals served as control subjects to study the oxidative stress status . Disease activity was assessed by laboratory indicators ( C-reactive protein , alpha1-acid glycoprotein , alpha1-antitrypsin , erythrocyte sedimentation rate , albumin , hemoglobin , and platelet count ) , sigmoidoscopy , and histology scores . Analysis of oxidative stress was assessed by plasma chemiluminescence and erythrocyte lipid peroxidation , both induced by tert butyl hydroperoxide ( t-BuOOH ) and by plasma malondialdehyde . Antioxidant status was assayed by total plasma antioxidant capacity ( TRAP ) and microsomal lipid peroxidation inhibition ( LPI ) . Superoxide dismutase ( SOD ) and catalase erythrocyte enzymatic activities were also determined . RESULTS No significant changes were observed in any laboratory indicator or in the sigmoidoscopy or histology scores , with the exception of erythrocyte sedimentation rate , which decreased with both treatments . Oxidative stress was demonstrated by significant decreases in TRAP and LPI levels , increased chemiluminescence induced by t-BuOOH , and higher SOD activity in patients with UC . Treatment with fish oil omega-3 fatty acids reverted the chemiluminescence induced by t-BuOOH and LPI to baseline levels but that did not occur when patients received only sulfasalazine .  Levels of plasma malondialdehyde , erythrocyte lipid peroxidation , and catalase were not different from those in the control group . CONCLUSIONS The results indicated that plasma oxidative stress occurs in patients with UC , and there was a significant decrease when the patients used sulfasalazine plus fish oil omega-3 fatty acids . However , there was no improvement in most laboratory indicators , sigmoidoscopy , and histology scores . The results suggested that omega-3 fatty acids may act as free radical scavengers protecting the patients against the overall effect of oxidative stress
The conversion of dialysis patients to a vitamin E-coated dialyser is associated with an improvement in circulating biomarkers of lipid peroxidation , which is of potential clinical benefit
BACKGROUND Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of cardiovascular disease and anaemia .
We conducted a systematic review and meta- analysis to examine the effect of Excebrane , a vitamin E-coated cellulose-based dialyser , on circulating biomarkers of lipid peroxidation , as surrogate markers of oxidative stress .