Oxidative Stress in Chronic Kidney Disease

Oxidative stress occurs when there is an overproduction of reactive oxygen species and/or a decline of antioxidant defenses. Oxidative stress is a significant burden to patients with chronic kidney disease (CKD), because of their declining renal function, and this can be worsened following renal replacement therapy. Previous studies have used in vivo circulating biomarkers to assess the burden of oxidative stress of CKD patients. For example, an increased oxidation of lipids, proteins, and nucleic acids, especially in the vascular wall, play critical roles in the early stages of atherogenesis in uremia patients. The pathogenesis of oxidative stress in uremia patients is complex, and includes several factors. Uremia-and dialysis-associated factors, including priming of leukocytes, impairment of antioxidant defense, exposure to dialysate endotoxins, use of bioincompatible hemodialysis dialyzer membranes or peritoneal dialysis solutions, and even intravenous iron supplementation, may contribute to the increased oxidative stress of CKD patients. The consequences of oxidative stress, such as atherosclerosis, amyloidosis, and anemia are discussed in detail. Several therapeutic strategies, including dietary administration of antioxidant vitamins (vitamin E and vitamin C), combination of antioxidants, the use of vitamin E-coated dialysis membranes and electrolyte-reduced water, appear to ameliorate the long-term complications of oxidative stress in uremic patients. Two initial randomized clinical studies have suggested that antioxidant therapy with N-acetylcysteine or vitamin E may improve the cardiovascular outcome of dialysis patients. Adequately powered randomized controlled trials must be performed in larger patient cohorts with longer follow-up to definitively demonstrate that correction of oxidative stress is beneficial for outcome of patients with chronic kidney disease.

並列關鍵字

oxidative stress ； chronic kidney disease ； antioxidant therapy

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