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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 370-372
Impact of hemodialysis session on endothelial function and oxidative stress - evaluation in maintenance hemodialysis

1 Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, AP, India
2 Department of Clinical Pharmacology and Theraputics, Nizams Institute of Medical Sciences, Hyderabad, AP, India

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Date of Web Publication26-Mar-2013

How to cite this article:
Taduri G, Venkata DK, Kutala VK, Mur N. Impact of hemodialysis session on endothelial function and oxidative stress - evaluation in maintenance hemodialysis. Saudi J Kidney Dis Transpl 2013;24:370-2

How to cite this URL:
Taduri G, Venkata DK, Kutala VK, Mur N. Impact of hemodialysis session on endothelial function and oxidative stress - evaluation in maintenance hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2020 Jun 1];24:370-2. Available from: http://www.sjkdt.org/text.asp?2013/24/2/370/109608
To the Editor,

Cardiovascular disease is a major cause of mortality and morbidity in dialysis patients. [1],[2],[3] Oxidative stress and endothelial dysfunction are the major contributors for cardiovascular diseases. [4],[5] Dialysis is a process where the exposure of blood to the artificial membrane may result in increased oxidative stress and/or worsen the endothelial function. [6],[7] At the same time, dialysis also clears the middle molecules and other oxidative end products, resulting in an improvement of the overall endothelial function and oxidative stress. [8],[9]

We undertook a prospective study with the aim to assess the impact of dialysis on the oxidative stress and endothelial function by analyzing the effect of a single hemodialysis session on these factors. The study was performed on 12 patients who were older than 18 years and had been on at least one month of regular maintenance hemodialysis for 4 hours thrice a week using polyflux dialyers. All the enrolled patients were ensured to have the same number of reuse of dialyser and the tubings. The study period was for two months. Patients who were irregular on dialysis, who had a problem with pulse evaluation and who did not provide consent for the study were excluded. The study was approved by the institutional ethical committee.

The oxidative stress was assessed by using malonaldehyde (MDA) as the marker. Adequacy of dialysis was assessed by the change in the blood urea concentration. Serum samples were collected before the start of the dialysis, after 2 hours of starting the dialysis and after 30 min of closing the dialysis. The serum was stored at -40°C. Serum was analyzed for blood urea by using the urease method. MDA was assessed by using the thiobarbituric acid method (TBA) method. Endothelial function was evaluated by using the "Dicrowin" machine (which is standardized with micropulse-wave analysis of UK) using the software loaded in the laptop. The readings were taken using a digital pulse probe on the right index finger before starting the dialysis, after giving salbutamol inhalation (400 μg), after 2 h of starting the dialysis and at 30 min after closing the hemodialysis.

Microsoft Excel was used to analyze the data. Student's "t" test was used to asess the difference between the groups. The data were presented as mean ± standard deviation. P-value of <0.05 was taken as statistically significant.

After excluding patients due to various factors, 12 patients were included in the study with a male:female ratio of 8:4, age (mean ± SD) of 37.5 ± 13.1 years, height (mean ± SD) of 164.1 ± 11.3 cm and weight (mean ± SD) of 56.9 ± 13.2 kg. Statistically significant reducetion in blood urea was observed during the dialysis and 30 min after hemodialysis (P <0.001). (Pre-dialysis 87.8 ± 17.5 mg/dL, during the dialysis 42 ± 12.3 mg/dL, 30 min after closure of dalysis 24.5 ± 7 mg/dL).

The basal value of the oxidative stress indicated by serum MDA is significantly high in dialysis patients in comparison with that seen in the 50 healthy voluntary blood donors who formed the control group (12.3 ± 3.5 vs. 6.5 ± 1.5 μmol/L). The MDA level decreased during the dialysis at 2 h (12.3 ± 3.5 vs. 10.7 ± 4.3 μmol/L) and 30 min (12.3 ± 3.5 vs. 7.4 ± 2.3 μmol/L) of post-dialysis. At 30 min post-dialysis, the reduction was statistically signifcant (P <0.001) [Figure 1].
Figure 1: Effect of a single session of hemodialysis on blood urea and oxidative stress.

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The basal parameters of endothelial function including reflex index (RI) and stiffness index (SI) were high at the start of hemodialysis in comparison with the healthy controls (RI: 60.4 ± 16 vs. 58 ± 16; SI: 9.95 ± 2.02 vs. 7.5 ± 2). During the dialysis, at 2 h, the RI increased by 5% and the SI index increased by 6%. Thirty minutes after the end of dialysis, the RI increased by 10% and the SI increased by 6%. However, the increase in the RI and SI did not attain statistical significance.

Our study demonstrates the effect of a single hemodialysis session on the two important parameters, viz. endothelial function and oxidative stress, simultaneously, which influence the cardiovascular outcomes in dialysis patients. The basal oxidative stress in the dialysis population was found to be high. Uremic status of the chronic kidney disease can explain the increased basal oxidative stress, which has been reported in previous studies. [6],[7] In our study, the oxidative stress decreased during the hemodialysis and more so at the end of hemodialysis [Figure 1]. The endothelial function in our study, asessed by the artreial stiffness, did not show significant change during a session of hemodialysis. The impact of dialysis on oxidative stress and endothelial function is conflicting in the published literature, with studies showing decreased and increased oxidative stress during the hemodialysis. [8],[10],[11] Our observation indicates that although the oxidative stress might have been aggravated during the dialysis process secondary to the exposure of blood to the artificial circuit as reported in the previous studies, the efficacy of the dialysis in removing the substances that are responsible for the oxidative stress may help in reducing the overall oxidative stress. It is true that, in this study, the biochemical evidence of decreased oxidative stress was not truly relected by immediate improvement in the arterial stiffness. However, we feel that our study highlights the need for regular hemodialysis, which can help decrease the oxidative stress and improve the endothelial function.

Conflict of Interest: Nil

   References Top

1.Cheung AK, Sarnak MJ, Yan G, et al. Athero-sclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 2000;58: 353-62.  Back to cited text no. 1
2.Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: A new paradigm. Am J Kidney Dis 2000;35:S117-31.  Back to cited text no. 2
3.Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003;42:1050-65.  Back to cited text no. 3
4.Gosmanova EO, Le NA. Cardiovascular complications in CKD patients: role of oxidative stress. Cardiol Res Pract 2011;2011:156326.  Back to cited text no. 4
5.Wang M, Tsai W, Chen J, Huang J. Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis 2005;45:494-501.  Back to cited text no. 5
6.Covic A, Goldsmith D, Florea L, Gusbeth-Tatomir P, Covic M. The influence of dialytic modality on arterial stiffness, pulse wave reflections, and vasomotor function. Perit Dial Int 2004;24:365-72.  Back to cited text no. 6
7.Mourad A, Carney S, Gillies A, Jones B, Nanra R, Trevillian P. Acute effect of haemodialysis on arterial stiffness: Membrane bioincompatibility? Nephrol Dial Transplant 2004;19:2797-802.  Back to cited text no. 7
8.Silva AM, Signori LU, Plentz RD, et al. Hemodialysis improves endothelial venous function in end-stage renal disease. Braz J Med Biol Res 2008;41:482-8.  Back to cited text no. 8
9.Migliacci R, Falcinelli F, Imperiali P, Floridi A, Nenci GG, Gresele P. Endothelial dysfunction in patients with kidney failure and vascular risk factors: Acute effects of hemodialysis. Ital Heart J 2004;5:371-7.  Back to cited text no. 9
10.Miyazaki H, Matsuoka H, Itabe H, et al. Hemodialysis impairs indothelial function via oxidative stress: effects of vitamin E-coated dialyzer. Circulation 2000;101:1002-6.  Back to cited text no. 10
11.Lilien MR, Koomans HA, Schröder CH. Hemodialysis acutely impairs endothelial function in children. Pediatr Nephrol 2005;20:200-4.  Back to cited text no. 11

Correspondence Address:
Gangadhar Taduri
Department of Nephrology, Nizams Institute of Medical Sciences, Hyderabad, AP
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DOI: 10.4103/1319-2442.109608

PMID: 23538367

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