Evaluation of Oxidative Stress Dynamics According to Dialysis Modalities: A Comparison of Hemodialysis and Peritoneal Dialysis

Abstract

Objective: This study aims to compare patients receiving hemodialysis (HD) or peritoneal dialysis (PD) treatment methods in terms of their susceptibility to oxidative stress (OS) and inflammation. Methods: The study cohort consisted of HD (n=50), PD (n=50), and healthy control (n=73) groups. We selected superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), total glutathione (tGSH), total antioxidant status (TAS), arylesterase (ARE), paraoxonase (PON), and vitamin D3 (Vit D3) as Antioxidant markers; myeloperoxidase (MPO), total oxidant status (TOS), oxidative stress index (OSI), and malondialdehyde (MDA) as Oxidant markers, and C-reactive protein (CRP) as Inflammatory marker for serum samples. Statistical differences between groups were evaluated; inter-parameter relationships were examined via correlation analysis, and independent predictors of OS were determined using multivariate stepwise regression analysis. Results: Oxidant parameters (MDA, TOS, OSI) and CRP levels were significantly higher in both dialysis groups compared to the control group (p<0.05). When the three groups were compared in terms of antioxidant parameters, it was observed that GPx, ARE, PON, and TAS levels were lowest in the HD group, while CAT, SOD, tGSH, and Vit D3 levels were lowest in the PD group. Significant differences between the HD and PD groups were also detected in SOD, Vit D3, MPO, and CRP levels (p<0.05). Correlation and regression analyses demonstrated a dynamic interaction between antioxidant enzymes and the dialysis process, identifying TAS, CAT, and PON as the primary determinants of the total oxidative load (p<0.05). Conclusion: Monitoring modality-specific compensatory antioxidant responses in ESRD patients is crucial for the prediction and management of oxidative damage progression and uremic complications. Keywords: Antioxidant system, chronic kidney disease, hemodialysis, inflammation, oxidative stress, peritoneal dialysis

Keywords

• : Antioxidant system
• chronic kidney disease
• hemodialysis
• peritoneal dialysis
• inflammation
• oxidative stress.

Supporting Institution

This study was supported by Atatürk University Scientific Research Projects under project number TYL-2023/13406 as a master's thesis.

Ethical Statement

This study was approved by the Atatürk University Faculty of Medicine Clinical Research Ethics Committee (Approval Date: 01.12.2022; Protocol Number: B.30.ATA.0.01.00/561).

Diyaliz Yöntemlerine Göre Oksidatif Stres Dinamiklerinin Değerlendirilmesi: Hemodiyaliz ve Periton Diyalizinin Karşılaştırılması

Abstract

Amaç: Bu çalışma, HD (hemodiyaliz) veya PD (periton diyalizi) tedavi yöntemlerini alan hastaaları oksidatif strese (OS) ve inflamasyona duyarlılık açısından karşılaştırmayı amaçlamaktadır. Yöntemler: Çalışma kohortu HD (n=50), PD (n=50) ve sağlıklı kontrol (n=73) gruplarından oluşmuştur. Serum örnekleri için Antioksidan belirteçler olarak süperoksit dismutaz (SOD), katalaz (CAT), glutatyon peroksidaz (GPx), toplam glutatyon (tGSH), toplam antioksidan durumu (TAS), arilesteraz (ARE), paraoksonaz (PON) ve D3 vitamini (Vit D3); Oksidan belirteçler olarak miyeloperoksidaz (MPO), toplam oksidan durumu (TOS), oksidatif stres indeksi (OSI) ve malondialdehit (MDA), ve İnflamatuvar belirteç olarak C-reaktif protein (CRP) seçilmiştir. Gruplar arasındaki istatistiksel farklılıklar değerlendirilmiştir. Parametreler arası ilişkiler korelasyon analizi yoluyla incelenmiştir ve oksidatif stresin bağımsız belirleyicileri çok değişkenli aşamalı regresyon analizi kullanılarak belirlenmiştir. Bulgular: Oksidan parametreler (MDA, TOS, OSI) ve CRP düzeyleri, kontrol grubuna kıyasla her iki diyaliz grubunda da anlamlı derecede daha yüksekti (p<0,05). Antioksidan parametreler açısından üç grup karşılaştırıldığında, HD grubunda GPx, ARE, PON ve TAS düzeylerinin en düşük olduğu, PD grubunda ise CAT, SOD, tGSH ve Vit D3 düzeylerinin en düşük olduğu gözlemlenmiştir. HD ve PD grupları arasında SOD, Vit D3, MPO ve CRP düzeylerinde de anlamlı farklılıklar tespit edilmiştir (p<0,05). Korelasyon ve regresyon analizleri, antioksidan enzimler ile diyaliz süreci arasında dinamik bir etkileşim olduğunu göstererek, TAS, CAT ve PON'u toplam oksidatif yükün birincil belirleyicileri olarak tanımlamıştır (p<0,05). Sonuç: ESRD hastalarında, oksidatif hasarın ilerlemesinin ve üremik komplikasyonların öngörülmesi ve yönetimi için, hastalığa özgü telafi edici antioksidan yanıtların izlenmesi çok önemlidir. Anahtar kelimeler: Antioksidan sistem, inflamasyon, hemodiyaliz, kronik böbrek hastalığı, oksidatif stres, periton diyalizi

Keywords

• Antioksidan sistem
• kronik böbrek hastalığı
• hemodiyaliz
• periton diyalizi
• inflamasyon
• oksidatif stres

Supporting Institution

Bu çalışma, Atatürk Üniversitesi Bilimsel Araştırma Projeleri kapsamında TYL-2023/13406 proje numarasıyla yüksek lisans tezi olarak desteklenmiştir.

Ethical Statement

Bu çalışma Atatürk Üniversitesi Tıp Fakültesi Klinik Araştırma Etik Kurulu tarafından onaylanmıştır (Onay Tarihi: 01.12.2022; Protokol Numarası: B.30.ATA.0.01.00/561).

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