NDT Advance Access originally published online on October 12, 2005
Nephrology Dialysis Transplantation 2005 20(12):2775-2782; doi:10.1093/ndt/gfi121
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Long-term use of vitamin E-coated polysulfone membrane reduces oxidative stress markers in haemodialysis patients
Department of Medicine and Clinical Science Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama and Innoshima General Hospital, Hiroshima, Japan
Correspondence and offprint requests to: Kazushi Nakao, MD, PhD, Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan. Email: nakao_kazu{at}ybb.ne.jp
Background. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and an independent predictor of overall mortality and cardiovascular outcome in haemodialysis (HD) patients. In the present study, we compared the effects of a vitamin E-coated polysulfone membrane (PSE) and a non-vitamin E-coated polysulfone membrane (PS) on oxidative stress markers such as ADMA.
Methods. Thirty-one HD patients were enrolled to this investigation. They were allocated into two groups: in the PSE group (n = 16), PSE was used for 6 months, followed by PS for an additional 12 months; in the PS group (n = 15), PS was used for the entire observation period. Plasma ADMA, oxidized low density lipoprotein (Ox-LDL) and malondialdehyde LDL (MDA-LDL) levels were measured at baseline, 3, 6, 12 and 18 months. Plasma ADMA in peritoneal dialysis (PD) patients and in healthy individuals was also measured.
Results. Predialysis concentrations of ADMA (0.72± 0.13 nmol/ml) were significantly higher in the HD group than in both PD patients (0.63±0.10 nmol/ml, P<0.01) and healthy individuals (0.44±0.01 nmol/ml, P<0.0001). Treatment with PSE for 6 months significantly reduced predialysis levels of ADMA (0.54±0.09 nmol/ml) compared with baseline (0.74±0.12 nmol/ml; P<0.01). Predialysis levels of Ox-LDL and MDA-LDL after 6 months therapy with PSE were also significantly lower than baseline values. Treatment with PS subsequent to treatment with PSE again increased ADMA, Ox-LDL and MDA-LDL back to baseline levels. In the PS group, ADMA, Ox-LDL and MDA-LDL levels remained unchanged during the entire treatment period of 18 months.
Conclusions. We confirmed that use of PSE reduced ADMA that had accumulated in HD patients. This finding indicates that PSE exerts anti-oxidant activity. A randomized controlled study will be required to determine whether PSE prevents cardiovascular diseases and other dialysis-related complications by reducing oxidative stress.
Keywords: ADMA; haemodialysis; oxidative stress; polysulfone; vitamin E-coated
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