Abstract
Oxidative stress is an important risk factor for cardiovascular disease and death in hemodialysis (HD) patients. However, whether biochemical and nutritional markers might be useful to stratify HD patients according to the risk of oxidative damage remains unclear. We investigated whether low-cost and easily available parameters such as the profile of nutrients intake, nutritional status, and antioxidant defenses can predict lipid and protein oxidation in HD patients. Forty-nine HD patients (women = 20, men = 29), ranging from 18 to 65 years of age (73.5%) were submitted to biochemical and nutritional analysis. At least 93.9% of HD patients had malnutrition. A patient's stratification according to nutritional risk was highly coherent with anthropometric parameters and nutrients intake, which were complementarily used as markers of malnutrition. Nutritional stratification was unable to reveal differences in the oxidative status. On the other hand, carbohydrate and zinc intake, serum zinc (Zn), glutathione peroxidase (GPx) activity, total antioxidant capacity (TAC), and nonprotein antioxidants (npAC) in serum were predictive markers of lipid (R2 = 0.588, P < 0.001) and protein (R2 = 0.581, P < 0.001) oxidation. Interestingly, GPx activity, TAC, and npAC exhibited good (>80% < 90%) or excellent (>90%) accuracy to estimate lipid oxidation (P ≤ 0.01). Regarding the prediction of protein oxidation, GPx activity and TAC presented regular accuracy (>70% < 80%), and Zn serum levels exhibited good sensitivity (P ≤ 0.01). Herein, we provided evidence that clinical characteristics relevant to predict different levels of lipid and protein oxidation in HD patients can be easily obtained, during routine hospital visits by means of the combined analyses of biochemical and nutritional parameters.
Highlights
End-stage renal disease (ESRD) and renal replacement therapy are closely associated with chronic inflammation, metabolic imbalance, decreased dietary intake, and nutritional derangements, which can be termed as protein energy wasting (PEW) [1]
The exclusion criteria were as follows: (i) patients who refuse to participate in the study, (ii) presence of cognitive deficit that makes the application of the questionnaires difficult [12], (iii) patients submitted to renal transplantation during the last 6 months, (iv) neoplastic disease, (vi) change in dialysis modality during the last 3 months, (vii) newly implanted catheters, (viii) hemodynamic instability, and (ix) patients with physical incapacity to stay in a standing position for anthropometric evaluation
We evaluated cardiometabolic risk factors and nutritional status in HD patients, emphasizing the association between nutritional status and oxidative stress markers
Summary
End-stage renal disease (ESRD) and renal replacement therapy are closely associated with chronic inflammation, metabolic imbalance, decreased dietary intake, and nutritional derangements, which can be termed as protein energy wasting (PEW) [1]. Imbalance in protein metabolism is the most pronounced biochemical disturbance of patients at ESRD. This alteration in protein metabolism is multifactorial and can be linked to reduced protein and energy intake, systemic inflammation, resistance to anabolic hormones including insulin and growth hormones, and direct loss of amino acids in the dialysate [2]. Metabolic imbalance and accumulation of uremic toxins are associated with the onset and progression of nutritional changes in ESRD patients [3]. The combined use of nutritional markers has been recommended to improve the prediction of morbidity and mortality risks associated with ESRD [6]
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