Antioxidants deficiency: a sensitive indicator of cardiometabolic risk in chronic renal failure?
Keywords:
Chronic renal failure (CRF), Antioxidants, Vitamin C, Vitamin EAbstract
Background: Antioxidant depletion occurring in chronic renal failure patients is an important cause of associated morbidity & mortality, which in turn imposes a great socioeconomic burden of health care. Early diagnosis & targeted management of this preventable deficiency may have a positive impact on the management of co morbidities associated with chronic renal failure.
Aims & Objectives: To evaluate the status of antioxidants as an early indicator of cardiometabolic risk in chronic renal failure patients.
Settings & Design: This was a randomised case Control study including 10 controls of either sex with normal renal function between age group 20-60 years and 15 patients of chronic renal failure on dialysis between the age group of 16 - 60 years.
Methods: 12 hour fasting venous blood samples were collected from all the participants and were assayed for various antioxidants.
Statistical analysis: Results were analyzed by unpaired t test, p value was determined & Correlation coefficient was calculated amongst various parameters.
Results: In the present study, significantly low levels of vitamin C ( Cases: 0.367 ± 0.13 mg/dl controls: 1.324 ± 0.61 mg/dl; p < 0.01) & vitamin E (cases: 0.235 ± 0.102 mg/dl, controls (0.854 ± 0.28 mg/dl; p < 0.01) were observed in chronic renal failure patients as compared to controls.
Conclusion: Diminished levels of Vitamin C & E in our study may be an indicator of increased oxidative stress which can be a responsible factor for increased incidence of cardiovascular complications. Supplementing these patients with recommended dosage of these vitamins may provide an essential tool to reduce the burden of suffering.
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References
K/DOQI Advisory Board Members. Clinical practice guidelines for chronic kidney disease. Part 4. Definition and Classification of Stages of chronic kidney disease. Am J Kidney Dis 2002;39:46-75.
Chronic Kidney Disease (Chronic Renal Failure), 2007. Available at http://www.merckmanuals.com/professional/genitourinary_disorders/renal_failure/chronic_kidney_disease.html. James I. McMillan, MD.
Human Nutrition BIO Center.net. The Past, Present and Future of Vitamins,1997. Available at http://centernet.okstate.edu/nutrition/antioxidants.html.
Vitamins – Production Methods. The History of the Vitamins. Available at www.slideshare.net/kdiwavvou/37-vitamins, 2009.
Vitamins. Information on the definition and classification of vitamins, 2008. Available at www.vitaminsontheweb.info/definition-and-classification-of-vitamins.
National Academies. Dietary Reference Intakes: The Vitamins, 2001. Available at http://www.nlm.nih.gov/medlineplus/ency/article/002404.html.
Science Daily. Discovery Shows New Vitamin C Health Benefits, Oregon State University, 2005. Available at http://www.sciencedaily.com/releases/2005/01/050111162230.html.
Story of Vitamin C's chemical discovery, 2010. Available at http://profiles.nlm.nih.gov/WG/Views/Exhibit/narrative/szeged.html.
Wolf G. The discovery of the antioxidant function of vitamin E: the contribution of Henry A. Mattill. J Nutr 2005;135:363-6.
Sure B. Dietary requirement for reproduction. II. The existence of a specific vitamin for reproduction. JBC1924;58:693-709.
Traber MG. Vitamin E. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins R etal, editors. Modern Nutrition in Health and Disease. Baltimore : Williams & Wilkins,10th ed; 2006:396-411.
Gilson T, Philip GA. Miscellaneous methods. In: Practical Clinical Chemistry. Little Brown and Company, 1st ed; 1975:634-6.
Harold V. Vitamins. In: Gowenlock AH, Bell M, editors. Practical Clinical Chemistry. Minnesota: Heinemann Medical, 5th ed; 1976:222-3.
Makoff R. Vitamin Replacement Therapy in Renal Failure Patients. Mineral Electrolyte Metab 1999;25:349-51.
John F, Sullivan MD, Albert B, Eisenstein MD. Ascorbic Acid Depletion During Hemodialysis. JAMA 1972;220:1697-9.
Deicher R, Walter HH. Vitamin C in Chronic Kidney Disease and Hemodialysis Patients. Kidney & Blood Pressure Research 2003;26:100-6.
Morena M, Cristol JP, et al. Convective and diffusive losses of vitamin C during hemodiafiltration session: a contributive factor to oxidative stress in hemodialysis patients. Nephrol Dial Transplant 2002;17:422-7.
May JM, Qu ZC, Whitesell RR, Cobb CE. Ascorbate recycling in human erythrocytes: role of GSH in reducing dehydroascorbate. Free Radic Biol Med 1996;20:543-51.
Henderson IS, Leung ACT, Shenkin A. Vitamin C status in continuous ambulatory peritoneal dialysis. Perit Dial Int1984;4:143-5.
Nakayama H, Akiyama S, Inagaki M, Gotoh Y, Oguchi K. Dehydroascorbic acid and Oxidative Stress in Hemodialysis Patients. Nephro Dial Transplant 2001;16:574-9.
Fouque D, et al. EBPG Guideline on Nutrition. Nephrol Dial Transplant 2007;22:45-87.
Bhogad RB, Suryakar AN, Joshi NG, Patil RY. Effect of Vitamin E Supplementation on Oxidative Stress in Hemodialysis Patients. IJCB 2008;23:233-7.
Karamouzis I, et al. Increase in Oxidative Stress but Not in Antioxidant Capacity with Advancing Stages of Chronic Kidney Disease. Am J Nephrol 2008;28:397-404.
Kadkhodaee M, Hemmati M, et al. Assessment of Plasma Antioxidant Status in Hemodialysis Patients. Therapeutic Apheresis and Dialysis 2008;12:147-51.
Galli F, Varga Z, et al. Vitamin E, lipid profile, and peroxidation in hemodialysis patients. Kidney International 2001;59:148-54.
Stein G, Richter G, Fünfstück R, Sperschneider H, Günther K. Serum vitamin E levels in patients with chronic renal failure. Int J Artif Organs 1983;6:285-7.
Drukker A, Itai T, Stankiewicz H, Goldstein R. Plasma vitamin E levels in uremic children and adolescents. Child Nephrol Urol 1989;9:208-10.
Himmelfarb J, et al. Alpha and gamma tocopherol metabolism in healthy subjects and patients with end-stage renal disease. Kidney Int 2003;64:978-9.
Fellah H, et al. Oxidative stress in end stage renal disease: evidence and association with cardiovascular events in Tunisian patients. Tunis Med 2006;84:724-9.
Lysaght MJ. Maintenance dialysis population dynamics: Current trends and long-term implications. J Am Soc Nephrol 2002;13:37-40.
Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey RM. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant 2005;20:1638-42.