Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Nephrology, Medical School, University of Ioannina, Ioannina, Greece.
Oxid Med Cell Longev. 2019 Jan 15;2019:9109473. doi: 10.1155/2019/9109473. eCollection 2019.
The disruption of balance between production of reactive oxygen species and antioxidant systems in favor of the oxidants is termed oxidative stress (OS). To counteract the damaging effects of prooxidant free radicals, all aerobic organisms have antioxidant defense mechanisms that are aimed at neutralizing the circulating oxidants and repair the resulting injuries. Antioxidants are either endogenous (the natural defense mechanisms produced by the human body) or exogenous, found in supplements and foods. OS is present at the early stages of chronic kidney disease, augments progressively with renal function deterioration, and is further exacerbated by renal replacement therapy. End-stage renal disease patients, on hemodialysis (HD) or peritoneal dialysis (PD), suffer from accelerated OS, which has been associated with increased risk for mortality and cardiovascular disease. During HD sessions, the bioincompatibility of dialyzers and dialysate trigger activation of white blood cells and formation of free radicals, while a significant loss of antioxidants is also present. In PD, the bioincompatibility of solutions, including high osmolality, elevated lactate levels, low pH, and accumulation of advanced glycation end-products trigger formation of prooxidants, while there is significant loss of vitamins in the ultrafiltrate. A number of exogenous antioxidants have been suggested to ameliorate OS in dialysis patients. Vitamins B, C, D, and E, coenzyme Q10, L-carnitine, a-lipoic acid, curcumin, green tea, flavonoids, polyphenols, omega-3 polyunsaturated fatty acids, statins, trace elements, and N-acetylcysteine have been studied as exogenous antioxidant supplements in both PD and HD patients.
活性氧物质的产生与抗氧化系统之间的平衡被打破，有利于氧化剂，这种情况被称为氧化应激（OS）。为了抵消促氧化剂自由基的破坏性影响，所有需氧生物都有抗氧化防御机制，旨在中和循环氧化剂并修复由此产生的损伤。抗氧化剂要么是内源性的（人体产生的天然防御机制），要么是外源性的，存在于补充剂和食物中。氧化应激存在于慢性肾脏病的早期阶段，随着肾功能恶化而逐渐加重，并且在肾脏替代治疗时进一步恶化。接受血液透析（HD）或腹膜透析（PD）的终末期肾病患者遭受加速的氧化应激，这与死亡率和心血管疾病风险增加有关。在 HD 期间，透析器和透析液的生物不相容性会引发白细胞的激活和自由基的形成，同时也会大量损失抗氧化剂。在 PD 中，溶液的生物不相容性，包括高渗透压、升高的乳酸水平、低 pH 值和晚期糖基化终产物的积累，会触发氧化剂的形成，而超滤液中会大量损失维生素。已经提出了许多外源性抗氧化剂来改善透析患者的 OS。维生素 B、C、D 和 E、辅酶 Q10、左旋肉碱、α-硫辛酸、姜黄素、绿茶、类黄酮、多酚、ω-3 多不饱和脂肪酸、他汀类药物、微量元素和 N-乙酰半胱氨酸已被研究作为 PD 和 HD 患者的外源性抗氧化补充剂。
