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Perit Dial Int 29(1): 89-101
2009
© 2009 International Society for Peritoneal Dialysis
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Clinical

ANTIOXIDANT STATUS OF PATIENTS ON PERITONEAL DIALYSIS: ASSOCIATIONS WITH INFLAMMATION AND GLYCOXIDATIVE STRESS

Isabella Sundl1, Johannes M. Roob2, Andreas Meinitzer3, Beate Tiran3, Gholamali Khoschsorur3, Bernd Haditsch2, Herwig Holzer2 and Brigitte M. Winklhofer–Roob1

Human Nutrition & Metabolism Research and Training Center Graz,1 Institute of Molecular Biosciences, Karl-Franzens University; Division of Clinical Nephrology and Hemodialysis,2 Department of Internal Medicine, and Clinical Institute of Medical & Chemical Laboratory Diagnostics,3 Medical University, Graz, Austria

Correspondence to: B.M. Winklhofer–Roob, Human Nutrition & Metabolism Research and Training Center Graz, Institute of Molecular Biosciences, Karl-Franzens University, Schubertstrasse 1, A-8010 Graz, Austria. brigitte.winklhoferroob{at}uni-graz.at

{diamondsuit} Background: Patients on peritoneal dialysis (PD) frequently exhibit oxidant–antioxidant imbalance, advanced glycation end-product overload, and subclinical inflammation but the interrelations between these pathophysiological changes have not been fully elucidated.

{diamondsuit} Subjects and Methods: To study possible associations, a cross-sectional study of antioxidant status, glycoxidative stress, and inflammation, using HPLC and ELISA methods, was undertaken in 37 PD patients and age- and sex-matched healthy controls.

{diamondsuit} Results: Plasma ascorbate concentrations were low in patients not taking at least low-dose vitamin C supplements. In patients taking vitamin C supplements, there was a positive relation between ascorbate and pentosidine concentrations. Vitamin E and carotenoid concentrations were comparable between patients and controls, while lycopene and lutein/zeaxanthin concentrations were lower. Interleukin-6, C-reactive protein (CRP), and pentosidine concentrations were elevated in PD patients. β-Cryptoxanthin, lycopene, and lutein/zeaxanthin concentrations were inversely related to interleukin-6 concentrations. β-Cryptoxanthin concentrations were also inversely related to CRP concentrations. Pentosidine showed a low dialysate-to-plasma ratio, indicating low peritoneal clearance. Pentosidine concentrations increased with duration of PD therapy, while {alpha}- and β-carotene concentrations decreased. Malondialdehyde concentrations were elevated compared to controls but remained within the normal range. Retinol concentrations decreased with PD therapy and were inversely related to interleukin-6 and CRP concentrations.

{diamondsuit} Conclusions: Low-dose vitamin C supplements and a carotenoid-rich diet should be recommended for PD patients to maintain normal antioxidant status and efficiently counteract the chronic inflammatory response, rather than high doses of vitamin C, which could play a role as a precursor of pentosidine.

KEY WORDS: Advanced glycation end products; ascorbate; carotenoids; interleukin-6; malondialdehyde; oxidative stress; pentosidine.

Received 5 November 2007; accepted 1 May 2008.






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