Cardiotoxic lipid peroxidation products in chronic renal failure in relation to severity of anemia and to left ventricular hypertrophy

ABSTRACT

To investigate the relationship between oxidative stress, anemia and cardiac injury in chronic renal failure [CRF] patients we measured two lipid peroxidation products [Malondialdehyde [MDA] and 4-hydroxynonenal [4-HNE]] by HPLC in 75 subject group I[15 apparently healthy volunteers as normal control], group II[15 CRF patients on conservative treatment], group III [15 CRF patients on regular haemodialysis [HD]] with Hb < 10g/dl], group IV [15 CRF patients on regular HD with Hb > 11g/dl]. group IV [15 anemic patients with normal kidney function]. [chocardiography was done to CRF patients and left ventricular mass index [LVMI] was estimated. Results of the study revealed that MDA and 4-HNE were significantly elevated in CRF patients [groups II, III, IV] and in non uremic anemic patients [group V] compared to control subjects [group I] [P < 0.001], [P < 0.001] for each group. Also significant increases in serum levels of these oxidative stress parameters in CRF patients under regular III] with Hb concentration < 10g/dl compared to those with Hb > 11g/dl [P < 0.001], [P < 0.001]. MDA and 4-HNE were elevated in group III [patients on regular HD with Hb < 10g/dl] compared to group II [conservatively treated group] but this difference was not statistically, significant [P > 0.05],[P > 0.05]. They were also elevated in CRF patient compared to anemic patients with normal kidney function [P < 0.001], [P < 0.001]. These parameters were significantly reduced after the HD session compared to before it in groups III and IV [P < 0.001], [P < 0.001] for each group. Serum MDA and 4-HNE showed significant negative correlations with Hb concentration [P < 0.001], [P < 0.001], and significant positive correlations with each of serum creatinine [P < 0.001], [P < 0.001], BUN [P < 0.001] [P < 0.001], and [[LVMI] [P < 0.001] [P < 0.001] in HD patients with Hb < 10g/dl. Similar correlation results were obtained in HD group with Hb > 11g/dl. These results lead to the conclusion that optimized correction of renal anemia as well as the use of biocompatible HD membranes may result in significant reduction of oxidative stress and therefore reduction of cardiac affection, reducing the co-morbidity of HD patients