Oxidative Stress in Peritoneal Dialysis Patients: Association with the Dialysis Adequacy and Technique Survival

Abstract

Introduction: Increased oxidative stress is suggested as one of the possible mechanisms of structural and functional damage to the peritoneal membrane in peritoneal dialysis patients. But there are few available data on the association of oxidative stress with peritoneal dialysis adequacy and technique survival. The present study was undertaken to investigate the association of oxidative stress biomarkers with the peritoneal dialysis adequacy and technique survival.

Methods: This prospective single-center observational study was conducted between January 2010 and May 2015. Adequacy of dialysis, malondialdehyde levels in the serum and erythrocytes (as an indicator of lipid peroxidation), the concentration of ceruloplasmin, transferrin, and sulfhydryl groups in the blood, and total peroxidase activity in erythrocyte (as indicators of antioxidant system) were determined in 44 stable ambulatory non-diabetic peritoneal dialysis patients.

Results: The follow-up period was 3 years. We identified a negative correlation between the serum level of malondialdehyde in the patients and total weekly Kt/V. Peritoneal weekly CrCl was positively correlated with the levels of transferrin, total peroxidase activity, and SH- groups. Daily peritoneal ultrafiltration had a positive correlation with the total peroxidase activity and the serum transferrin levels. The results of the Kaplan-Meier analysis and the log-rank test also demonstrated a significant difference in the cumulative technique survival rate between the patients with ceruloplasmin level ≤0.19 g/l and ≥0.2 g/l.

Conclusions: The results mentioned above could be considered as one of the ways to explain better technique survival in PD patients.

Keywords: Adequacy; oxidative stress; peritoneal dialysis; technique survival.

Figure 1

Serum levels of ceruloplasmin in the studied groups on the left side: “technique failures” group (n = 16), on the right side: “technique survival” group (n = 28); P < 0.0001

Figure 2

Kaplan–Meier technique survival (death censored) curves in PD patients dichotomized according to the serum ceruloplasmin level in the 3-year follow-up. Dotted line: Serum ceruloplasmin level ≤0.19 g/l; solid line: serum ceruloplasmin level ≥0.2 g/l (χ² = 11.3, P = 0.0008)