Nephrology Dialysis Transplantation, Vol 12, Issue 11 2312-2317, Copyright © 1997 by Oxford University Press
J Cristol, J Bosc, S Badiou, M Leblanc, R Lorrho, B Descomps and B Canaud
Oxidative stress can produce profound alterations to cellular membrane
lipids, impairing cell metabolism and viability. This phenomenon,
previously observed in haemodialysis patients, had been proposed as a
significant factor in regard to haemodialysis-related shortened red blood
cells (RBC) survival. In the present study, several parameters associated
with oxidative stress were evaluated in a group of haemodialysis patients
either receiving erythropoietin therapy (n=12, mean erythropoietin dose
88±24 U/kg/week) or not receiving such therapy (n=20), and in 38
controls. Malonyldialdehyde (MDA, nmol/ml), an end-product of lipid
peroxidation, and RBC anti-oxidant systems were measured, including RBC
&agr;-tocopherol (RBC vitamin E, mg/l), RBC glutathione (GSH,
nmol/mgHb), and RBC superoxide dismutase activity (SOD, U/mgHb). Plasma
vitamin E concentrations were also evaluated. Finally, oral vitamin E
supplementation (500 mg daily), an exogenous antioxidant, was administered
for 6 months to seven patients from the dialysis group receiving
erythropoietin while oxidative parameters were repeatedly evaluated and
erythropoietin requirements monitored, in order to appreciate the
therapeutic relevance of an antioxidant supplementation. An elevation of
serum MDA was observed in all haemodialysis patients and a significant
decrease in RBC vitamin E, despite normal serum vitamin E levels.
Furthermore, the reduction in RBC vitamin E was more important in patients
treated with erythropoietin. Vitamin E supplementation resulted in a
significant increase in RBC vitamin E (from 0.3±0.1 to
1.2±0.2 mg/l of pellet) and a reduction in erythropoietin dose
(from 93±24 to 74±26 U/kg/week) while maintaining
stable haemoglobin concentrations. These results suggest that the oxidative
stress could be one of the resistance factors to erythropoietin response in
haemodialysis and that vitamin E supplementation could have a sparing
effect on erythropoietin dosage requirement. Key
words: antioxidant; erythropoietin; haemodiafiltration; lipid
peroxidation; oxidative stress; vitamin E
ORIGINAL ARTICLES
Erythropoietin and oxidative stress in haemodialysis: beneficial effects of vitamin E supplementation
Departments of Biochemistry and Nephrology, Lapeyronie Hospital, 34295 Montpellier, France; Corresponding author
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