THE EVALUATION OF THE EFFECT OF THE TREATMENTS ON OXIDATIVE STRESS AND INFLAMMATION IN PATIENTS RECEIVING DIFFERENT DIALYSIS MODALITIES

Abstract

ABSTRACT Aim: To evaluate the effects of different dialysis methods on oxidative stress and inflammation in patients with end-stage renal disease (ESRD) who are newly enrolled in a routine dialysis program. Material and Methods: In this prospective study, 138 ESRD patients and 30 healthy volunteers were evaluated. Fifty-four of 73 hemodialysis (HD) patients and 51 of 65 periton dialysis (PD) patients completed the study. Other patients were excluded from the study. The levels of superoxide dismutase (SOD) and total antioxidant capacity (TAC) were measured to determine the oxidative stress status, and IL-6, IL-10, and F2 isoprostane levels were measured to determine the inflammation status, just before the start of dialysis treatment and at 6 months. Results: At the beginning of the study, hs-CRP and IL-6 levels were significantly higher in the patient group compared to the control group (p<0.001, p<0.001, respectively), and IL-10 levels were significantly lower (p=0.008). The hs-CRP and IL-10 levels in the HD group were found to be similar at the beginning of the study and in the 6th month. On the other hand, IL-6 levels decreased significantly compared to baseline values at 6 months (p=0.016). In the PD group, no difference was observed in terms of hs-CRP and IL-10 levels at the beginning and the 6th month (p>0.05), but IL-6 levels were found to be decreased compared to baseline at the 6th month (p<0.001). When HD and PD patient groups were compared with each other, no difference was found between the groups in terms of hs-CRP and IL-10 levels in the 6th month of dialysis treatment. IL-6 levels were found to be significantly higher in the HD group (p<0.001). At the beginning of the study, the F2 isoprostane level was significantly higher in the patient group than the control group (p<0.001), whereas the SOD and TAC levels were significantly lower (p=0.001, p=0.024, respectively). In the HD group, the F2 isoprostane level was found to be significantly higher at 6 months compared to baseline (p=0.019). There was no significant change in SOD and TAC levels. There was no significant difference in F2 isoprostane and TAC levels at 6 months from baseline in the PD group, whereas SOD levels were found to be significantly lower (p=0.015). Conclusion: The oxidative status found in ESRD patients increases with dialysis treatments. Oxidative stress increase is more prominent in HD patients. Therefore, we think that giving antioxidant treatment in patient groups undergoing dialysis treatment may benefit complications related to oxidative stress.

Keywords

• hemodialysis
• peritoneal dialysis
• oxidative stress

FARKLI DİYALİZ YÖNTEMLERİ ALAN HASTALARDA TEDAVİLERİN OKSİDATİF STRES VE İNFLAMASYON ÜZERİNDEKİ ETKİSİNİN DEĞERLENDİRİLMESİ

Abstract

Öz Amaç: Rutin diyaliz programına yeni başlayan son dönem böbrek yetmezliği (ESRD) olan hastalarda farklı diyaliz yöntemlerinin oksidatif stres ve inflamasyon üzerine etkilerini değerlendirmek. Gereç ve Yöntemler: Bu prospektif çalışmada 138 SDBY hastası ve 30 sağlıklı gönüllü değerlendirildi. 73 hemodiyaliz (HD) hastasının 54'ü ve 65 periton diyalizi (PD) hastasının 51'i çalışmayı tamamladı. Diğer hastalar çalışma dışı bırakıldı. Oksidatif stres durumunu belirlemek için süperoksit dismutaz (SOD) ve toplam antioksidan kapasite (TAC) seviyeleri, inflamasyon durumunu belirlemek için IL-6, IL-10 ve F2 izoprostan seviyeleri, diyaliz tedavisi başlamadan hemen önce ölçüldü ve 6. ayda ölçüldü. Bulgular: Çalışmanın başında hasta grubunda kontrol grubuna göre hs-CRP ve IL-6 düzeyleri anlamlı olarak yüksek (sırasıyla p<0.001, p<0.001), IL-10 düzeyleri anlamlı olarak düşüktü ( p=0.008). HD grubunda hs-CRP ve IL-10 düzeyleri çalışmanın başında ve 6. ayda benzer bulundu. IL-6 seviyeleri ise 6. ayda başlangıç değerlerine göre anlamlı olarak azaldı (p=0.016). PH grubunda başlangıç ve 6. ay hs-CRP ve IL-10 düzeyleri açısından fark izlenmezken (p>0,05), ancak 6. ayda IL-6 düzeylerinin başlangıca göre düştüğü saptandı. (p<0.001). HD ve PH hasta grupları kendi aralarında karşılaştırıldığında diyaliz tedavisinin 6. ayında hs-CRP ve IL-10 düzeyleri açısından gruplar arasında fark saptanmadı. IL-6 düzeyleri HD grubunda anlamlı olarak yüksek bulundu (p<0.001). Çalışmanın başında F2 izoprostan düzeyi hasta grubunda kontrol grubuna göre anlamlı olarak yüksek (p<0,001), SOD ve TAC düzeyleri anlamlı olarak düşüktü (sırasıyla, p=0,001, p=0,024). HD grubunda 6. ayda F2 izoprostan düzeyi başlangıca göre anlamlı olarak yüksek bulundu (p=0.019). SOD ve TAC düzeylerinde anlamlı bir değişiklik olmadı. PH grubunda 6. ayda F2 izoprostan ve TAC düzeylerinde başlangıca göre anlamlı fark bulunmazken, SOD düzeyleri anlamlı olarak düşük bulundu (p=0.015). Sonuç: SDBY hastalarında bulunan oksidatif durum diyaliz tedavileri ile artmaktadır. Oksidatif stres artışı HD hastalarında daha belirgindir. Bu nedenle diyaliz tedavisi gören hasta gruplarında antioksidan tedavi verilmesinin oksidatif strese bağlı komplikasyonlara fayda sağlayabileceğini düşünüyoruz.

Keywords

• hemodiyaliz
• periton diyalizi
• oksidatif stres

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