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논문분류	춘계학술대회 초록집
제목	Effect of dialysis modality on chronic inflammation and oxidative stress in maintenance hemodialysis patients
저자	Minoru Satoh
출판정보	2022; 2022(1):
키워드
초록	The presence of oxidative stress have been widely documented in end-stage renal disease patients receiving maintenance hemodialysis (HD). Oxidative stress can activate a variety of transcription factors, which lead to the various expression of inflammatory pathway genes. Chronic inflammation contributes to long-term complications in HD patients, such as cardiovascular disease, atherosclerosis, major causes of mortality in these patients. Oxidative stress, which induce chronic inflammation, remains an attractive target for cardiovascular prevention and therapy in HD patients. The enhanced oxidative stress status that characterizes HD patients is mainly due to loss of antioxidants during renal replacement therapy, and leukocyte activation that leads to accumulation of oxidative products. HD induces biochemical alterations caused by the contact of blood with dialysis devices. It is commonly attributed to the constantly renewed activation of circulating neutrophils and monocytes following blood passage through dialysis circuits and subsequent generation of activated complement components due to contact of plasma with bioincompatible membranes and/or transfer of endotoxins from the dialyzate to the blood compartment. Meta-analysis data shows that antioxidant supplementation reduces cardiovascular risk in HD patents. Vitamin E has been also used as a blood surface modifier of polysulfone membrane with the aim of further improving biocompatibility. Clinical datas show vitamin E-coated dialyzer therapy can significantly reduce the oxidative stress and inflammation status compared with non-coated dialyzer. Based on the available data, the best renal replacement therapy for reducing oxidative stress is hemodiafiltration (HDF) with ultrapure dialysate and biocompatible synthetic membranes. Randomized trials have shown reduced all-cause and cardiovascular mortality on HDF compared to high-flux HD with attenuated inflammation and anti-oxidant capacity. Online HDF is now gaining rapid clinical acceptance worldwide. In Japan, pre-dilution online-HDF is mainly performed, and improvement in survival rate has been shown on the condition of convection volume is 40 L/session or more. Electrolyzed water generated on the cathode side reportedly displays anti-oxidative properties, and application of electrolyzed water to HD systems suppresses oxidative markers in patients on HD. Electrolyzed water contains hydrogen molecule (H2) approximately 50 ppb. H2 has a unique biological capacity to act as an antioxidative and anti-inflammatory substance. The use of an H2-enriched solution may prove to be a novel approach to ameliorate dialysis-related complications.
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