Oxidative stress and inflammation in hemodialysis patients

Am J Kidney Dis. 2001 Dec;38(6):1408-13. doi: 10.1053/ajkd.2001.29280.


Dialysis is associated with an increased generation of oxidants, which play an important part in the development of endothelial dysfunction and atherogenesis. Markers of oxidative stress include F2-isoprostanes and ethane. Measurements in dialysis patients before dialysis showed higher levels of esterified plasma F2-isoprostanes (1.62 +/- 0.73 ng/mL) than in control subjects (0.27 +/- 0.10 ng/mL) (P < 0.001). Furthermore, levels also correlated with high plasma C-reactive protein (CRP) levels (r =.48, P = 0.015). Breath ethane levels for dialysis patients (N = 19) were 6.32 +/- 3.16 pmol/kg-min, in contrast to 3.08 +/- 1.50 pmol/kg-min in control subjects (N = 11, P < 0.005). Analysis to investigate the relationship between CRP levels and outcome indicated that there was a significant difference in mortality rate over a 3-year period between patients with low and high CRP values (P < 0.001). Patients with high CRP (> 16.8 mg/L) levels were more than twice as likely to die as patients with low CRP levels (relative risk [RR] = 2.16; 95% confidence interval [CI], 1.50-3.09). CRP values were a significant predictor of mortality even after controlling for diabetes, albumin, ferritin, and age at commencement of dialysis. The RR for CRP after adjustment was 1.58 (95% CI, 1.06-2.34, P = 0.024). There were no significant interactions between CRP and other predictors of mortality, indicating that high CRP levels have an additive effect on the mortality risk. These findings show that hemodialysis patients are exposed to both oxidative stress and inflammation.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Acute-Phase Reaction / etiology*
  • Acute-Phase Reaction / metabolism
  • C-Reactive Protein / metabolism
  • Diabetes Complications
  • Diabetes Mellitus / metabolism
  • F2-Isoprostanes / metabolism*
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy
  • Lipid Peroxidation
  • Longitudinal Studies
  • Oxidative Stress*
  • ROC Curve
  • Reactive Oxygen Species / metabolism
  • Renal Dialysis / adverse effects*
  • Risk Assessment
  • Serum Amyloid A Protein / metabolism
  • Survival Analysis


  • F2-Isoprostanes
  • Reactive Oxygen Species
  • Serum Amyloid A Protein
  • C-Reactive Protein