The study of oxidative status in children with end stage renal disease on regular hemodialysis

Abstract

Background: Oxidative stress has long been demonstrated in haemodialysis patients. However, the factors influencing their oxidative status have not been characterized extensively in these patients. Despite heterogeneity in the oxidative stress levels in the CKD population, there has been little effort to measure patient oxidative stress levels before the use of any anti-oxidant therapies to optimize outcome. Objectives: Assessment of oxidative stress and the effects of using antioxidant medications on oxidative status in children with end stage renal disease under regular hemodialysis. Subjects and Methods: 70 children were included in this study and were categorized into 2 groups: Group (1): 35 children with ESRD on regular haemodialysis. Their ages ranged from 8 to 15 years old. They were 14 males and 21 females. All patients were undergoing haemodialysis three times per week, with each dialysis session lasting for three to four hours. Group (2): 35 healthy children with matched age and sex that were serving as control group. All patients were receiving antioxidant drugs regularly for 3 months. These antioxidant drugs were vitamin E in a dose of 5 mg/kg/day, vitamin C in a dose of 100-200 mg /day, N-Acetyl Cysteine in a dose of one sachet (200 mg) twice daily with meal. All children in both groups were subjected to: (a) complete history taking. (b) Full clinical examination. (c) Laboratory Investigations [Routine Investigations: CBC, blood urea, serum creatinine and BUN, PTH and PT, PTT and Bleeding Time. Specific Investigations: Measuring levels of 1-Interleukin-1β, tumor necrosis factor alpha, thiobarbituric acid reactive substances and malondialdehyde]. Results: There was an increase in markers of oxidative stress in children with end-stage renal disease on regular haemodialysis in the form of: 1) Increase serum level of interleukin 1β (IL-1β). 2) Increase serum level of tumor necrosis factor alpha (TNF-α). 3) Increase serum level of thiobarbituric acid reactive substances (TBARS). 4) Increase serum level of malondialdehyde (MDA). These levels were decreased with antioxidant drugs used in this study. Conclusion: The high levels of oxidative stress markers were decreased after regular therapy by antioxidant medications for 3 months in the form of vitamin E (5 mg/kg/day), vitamin C (100-200 mg /day) and N-Acetyl Cysteine (one sachet (200 mg) twice daily with meal).