A Study of Bio-Markers of Oxidative Stress and Inflammation in Chronic Kidney Disease

Abstract

Chronic Kidney Disease (CKD) is one of the most important health challenges faced by the world today, with new cases being added at an alarming rate. Controlling traditional risk factors has not been effective in bringing down the incidence of the disease. CKD is associated with inflammation, morbidity, poor quality of life, decreased life-expectancy and death. Oxidative stress represents the imbalance between pro- oxidants and antioxidants in our body. Though a number of studies have focussed on the association between CKD and oxidative stress, majority of them are based on patients on hemodialysis. Moreover, there is confusion about the way the levels of some of these biomarkers vary in response to oxidative stress. This study was designed to study the biomarker of inflammation (CRP), MDA as a marker of oxidative stress, and SOD, GPx and TAC as parameters of antioxidant activity in controls and patients in different stages of CKD. We found that CRP and MDA values increase as disease progresses while there is decrease in the levels of SOD and GPx. The TAC values in patients do not vary much from that of controls. Efforts should be made to identify and reduce large funds to face this challenge, people in the developing countries are reeling under the tremendous financial, psychological and emotional burden of the disease due to insufficient infrastructure and resources available to deal with the disease. Scientists are looking at not just traditional risk factors but also non-traditional ones to help in early detection of the disease so as to initiate treatment early and probably try to reverse this condition or at least delay adverse outcomes. Reactive Oxygen Species (ROS) are free radicals which are constantly being produced in our body during various metabolic processes. When healthy, our body is endowed with the ability to deal with these attackers with the help of antioxidant mechanisms. Trouble starts brewing when the subtle balance tilts in favour of the free radicals. They gain an upper hand while the defence mechanism lags behind. Cellular antioxidants are overwhelmed by repeated oxidative insults. The production of ROS soon cascades leading to a scenario of tissue damage, cell death and disease. ROS cause tissue damage by a variety of different mechanisms which include DNA & protein damage, lipid peroxidation, stimulating release of pro-inflammatory cytokines, etc. (2) This disturbance in the delicate equilibrium of pro-oxidants:antioxidants in favour of the pro-oxidants is termed as oxidative stress. In short, oxidative stress represents an imbalance between the production and manifestation of ROS and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. Oxidative stress may be the sole cause of some disease but more often it weakens the immune system and makes the body vulnerable to diseases caused by other factors. It may also worsen existing conditions and slow down healing process. CKD is associated with increased inflammation. (3) Chronic inflammation in the body is measured by the elevated levels of inflammatory markers and CRP is the marker of choice in monitoring the acute phase response as it increases to a relatively high concentration compared to basal concentration.