Abstract
Introduction Increased oxidative stress and blunted anti-oxidant mechanisms are important problems in hemodialysis (HD) patients. Reactive oxygen species (ROS) act directly on proteins, leading to the formation of oxidized amino acids. Advanced oxidation protein products (AOPP) are among these substances. Many oxidant substances increase the level of AOPP. Iron is an element with strong oxidant capacity, especially when used intravenously. It is thought that iron treatment further increases the oxidative stress in HD patients. We aimed to investigate the relationship between AOPP and inflammatory status in HD patients. Materials and Methods Patients who were on maintenance HD program without additional co-morbidities and no history of use of intravenous iron within the last two weeks were recruited in the study. The blood samples taken just before the dialysis session were analyzed for AOPP, serum iron, total iron binding capacity (TIBC), ferritin, C-reactive protein (CRP), ß2-microglobulin, fibrinogen, interleukin (IL)-1, IL-6 and tumor necrosis factor-α levels besides routine biochemical measurements and complete blood count. Results The number of patients included in the study was 102 (n: 53 female, %52.0) and the mean age was 47.6±13.9 years. The mean transferrin saturation was 25.4%. AOPP levels, iron use in patients was higher compared to patients who do not use (respectively 2.58±0.19 mmol/l and 2.50 ±0.16mmol/l, p = 0.046). We did not detect statistically significant correlation of AOPP levels with iron parameters and other inflammatory markers. Conclusion The present study showed that intravenous iron therapy does not increase oxidative stress. Although serum AOPP level was higher in patients on intravenous iron treatment, it was not correlated with iron indices and inflammatory markers. So, intravenous iron may exert its oxidant effect free from serum iron indices.
Highlights
Increased oxidative stress and blunted anti-oxidant mechanisms are important problems in hemodialysis (HD) patients
The blood samples taken just before the dialysis session were analyzed for Advanced oxidation protein products (AOPP), serum iron, total iron binding capacity (TIBC), ferritin, C-reactive protein (CRP), ß2-microglobulin, fibrinogen, interleukin (IL)-1, IL-6 and tumor necrosis factor-α levels besides routine biochemical measurements and complete blood count
AOPP levels, iron use in patients was higher compared to patients who do not use
Summary
Increased oxidative stress and blunted anti-oxidant mechanisms are important problems in hemodialysis (HD) patients. Reactive oxygen species (ROS) act directly on proteins, leading to the formation of oxidized amino acids. It is thought that iron treatment further increases the oxidative stress in HD patients. Overproduction of ROS or attenuated antioxidant defense mechanisms causes oxidative stress by way of structural and functional modifications in biomolecules. Increased oxidative stress and attenuated antioxidant mechanisms are important problems in hemodialysis patients.[1] Bio-incompatible hemodialysis membranes, contaminated dialysis solutions and other similar causes stimulate release of proinflammatory cytokines like interleukin (IL)-1, IL-6 and tumor necrosis factor-alpha (TNF-α).[2] Polymorphonuclear leukocytes which are activated by cytokines release ROS that in turn activates nuclear factor kappa-B (NF-κB), the transcription factor of cytokines, beginning a vicious circle between cytokines and ROS.[3]. Reactive oxygen species causes oxidation of amino acids directly. The resultant products are called ‘advanced oxidation protein products’ (AOPP).[5]
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