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NDT Advance Access published online on July 22, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl376
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 14, 2006
Accepted May 30, 2006

Original Article

A systematic review of the effect of the Excebrane dialyser on biomarkers of lipid peroxidation

Marie Anne Sosa 1, Ethan M. Balk 2, Joseph Lau 2, Orfeas Liangos 3, Vaidyanathapuram S. Balakrishnan 4, Nicolaos E. Madias 3, Brian J. G. Pereira 4, and Bertrand L. Jaber 3 *

1 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA; Division of Nephrology, Caritas St Elizabeth's Medical Center, Boston, MA, USA
2 Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
3 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA; Division of Nephrology, Caritas St Elizabeth's Medical Center, Boston, MA, USA; Division of Nephrology, Tufts-New England Medical Center, Boston, MA, USA
4 Division of Nephrology, Tufts-New England Medical Center, Boston, MA, USA

* To whom correspondence should be addressed.
Bertrand L. Jaber, E-mail: bertrand.jaber{at}caritaschristi.org



  Abstract

Background. Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of cardiovascular disease and anaemia. We conducted a systematic review and meta-analysis to examine the effect of Excebrane, a vitamin E-coated cellulose-based dialyser, on circulating biomarkers of lipid peroxidation, as surrogate markers of oxidative stress.

Methods. The primary sources used to identify candidate studies included PubMed, the Cochrane Central Register of Controlled Trials, a bibliography provided by the dialyser manufacturer, and a manual search of abstracts from proceedings of scientific meetings and review articles. Studies were selected for analysis if their design included a comparator group (primarily within patient comparison, i.e. pre- and post-study evaluations). For the meta-analysis, we computed the overall change of the outcome from baseline using a random-effects model. A supplemental analysis was performed in which the absolute levels of these biomarkers of lipid peroxidation were converted to a common unit by calculating standardized effect sizes.

Results. Fourteen peer-reviewed articles met the criteria. The studies consisted of 11 single arm, one randomized crossover and two randomized controlled trials, with a total of 37 to 158 evaluable patients, according to the outcome of interest analysed. Due to the paucity of randomized trials, the meta-analysis was limited to the Excebrane arm of each study. When the studies were combined according to similar measurement units, the overall mean decrease in malondialdehyde (MDA) level was -0.3 mM (95% CI, -0.5 to -0.1 mM; seven studies) and -0.8 nmol/mg low-density lipoprotein (LDL) (95% CI, -1.3 to -0.4 nmol/mg LDL; three studies), respectively. The summary estimate revealed a non-significant decrease in pre-dialysis thiobarbituric acid reactive substances (TBARS) level of 0.4 µM (95% CI, -1.2 to 0.4 µM; three studies). When the MDA and TBARS studies were combined using the standardized effect size, the mean decrease in these biomarkers of lipid peroxidation was statistically significant at -1.7 units (95% CI, -2.7, -0.7 units; 13 studies). A meta-analysis on the effect of Excebrane on pre-dialysis levels of oxidized-LDL could not be performed due to study heterogeneity.

Conclusion. The conversion of dialysis patients to a vitamin E-coated dialyser is associated with an improvement in circulating biomarkers of lipid peroxidation, which is of potential clinical benefit.

Keywords: cardiovascular disease; Excebrane; haemodialysis; lipid peroxidation; meta-analysis; oxidative stress; vitamin E.
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