TY - JOUR
T1 - Haemolysis in haemodialysis patients
T2 - Evidence for impaired defence mechanisms against oxidative stress
AU - Weinstein, Talia
AU - Chagnac, Avry
AU - Korzets, Asher
AU - Boaz, Mona
AU - Ori, Yaacov
AU - Herman, Michal
AU - Malachi, Tsipora
AU - Gafter, Uzi
PY - 2000
Y1 - 2000
N2 - Background. Uraemic patients have a decreased ability to withstand oxidative stress. It is postulated that their antioxidant capacity is reduced, yet the mechanism remains unclear. Recently 33 haemodialysis (HD) patients were exposed to chloramine contamination in the water supply. This led to haemolysis in 24 patients, while nine were unaffected. In the former group haemoglobin decreased from 11.7 ± 1.1 to 8.5 ± 1.4 g/dl (P < 0.0001) and returned to 11.4 ± 0.9 g/dl (P < 0.0001) following recovery. During haemolysis, haptoglobin was 38.4 ± 10.6 vs 138.1 ± 8.3 ng/dl (P < 0.0001) following recovery. Methods. To explore the factors affecting the severity of haemolysis we studied extracellular and intracellular anti-oxidant defence mechanisms 3 months after recovery. In 29 patients and 20 controls we determined plasma glutathione (GSH), and the erythrocyte enzymes glutathione peroxidase (GSH-Px), glutathione reductase (GSH-Rx), and superoxide dismutase (SOD). Serum malondialdehyde (MDA) was measured as a marker of oxidative stress. Results. Plasma GSH was lower in patients as compared to controls (5.49 ± 0.26 vs 7.4 ± 0.5 μmol/l, P < 0.005). There was an inverse correlation between GSH and the degree of haemolysis (r = -0.42, P < 0.02). Patients had higher GSH-Rx (4.64 ± 0.15 vs 3.97 ± 0.12 U/gHb, P < 0.02), lower GSH-Px (29.7 ± 1.85 vs 35.5 ± 1.62 U/gHb, P < 0.001), and similar SOD (0.63 ± 0.02 vs 0.51 ± 0.02 U/mgHb) as compared to controls. There was no correlation between the enzyme levels and the degree of haemolysis. MDA was higher in patients (2.37 ± 0.07 vs 0.97 ± 0.1 nmol/ml, P < 0.0001). There was a correlation between MDA and the years patients were on HD (r = 0.43, P < 0.02). Conclusions. These data indicate that HD patients have an impaired anti-oxidant response, which may be attributed in part, to plasma GSH deficiency. Patients with the lowest plasma GSH levels are more susceptible to oxidative stress and consequent haemolysis.
AB - Background. Uraemic patients have a decreased ability to withstand oxidative stress. It is postulated that their antioxidant capacity is reduced, yet the mechanism remains unclear. Recently 33 haemodialysis (HD) patients were exposed to chloramine contamination in the water supply. This led to haemolysis in 24 patients, while nine were unaffected. In the former group haemoglobin decreased from 11.7 ± 1.1 to 8.5 ± 1.4 g/dl (P < 0.0001) and returned to 11.4 ± 0.9 g/dl (P < 0.0001) following recovery. During haemolysis, haptoglobin was 38.4 ± 10.6 vs 138.1 ± 8.3 ng/dl (P < 0.0001) following recovery. Methods. To explore the factors affecting the severity of haemolysis we studied extracellular and intracellular anti-oxidant defence mechanisms 3 months after recovery. In 29 patients and 20 controls we determined plasma glutathione (GSH), and the erythrocyte enzymes glutathione peroxidase (GSH-Px), glutathione reductase (GSH-Rx), and superoxide dismutase (SOD). Serum malondialdehyde (MDA) was measured as a marker of oxidative stress. Results. Plasma GSH was lower in patients as compared to controls (5.49 ± 0.26 vs 7.4 ± 0.5 μmol/l, P < 0.005). There was an inverse correlation between GSH and the degree of haemolysis (r = -0.42, P < 0.02). Patients had higher GSH-Rx (4.64 ± 0.15 vs 3.97 ± 0.12 U/gHb, P < 0.02), lower GSH-Px (29.7 ± 1.85 vs 35.5 ± 1.62 U/gHb, P < 0.001), and similar SOD (0.63 ± 0.02 vs 0.51 ± 0.02 U/mgHb) as compared to controls. There was no correlation between the enzyme levels and the degree of haemolysis. MDA was higher in patients (2.37 ± 0.07 vs 0.97 ± 0.1 nmol/ml, P < 0.0001). There was a correlation between MDA and the years patients were on HD (r = 0.43, P < 0.02). Conclusions. These data indicate that HD patients have an impaired anti-oxidant response, which may be attributed in part, to plasma GSH deficiency. Patients with the lowest plasma GSH levels are more susceptible to oxidative stress and consequent haemolysis.
KW - Chloramines
KW - Glutathione
KW - Haemodialysis
KW - Haemolysis
KW - Malondialdehyde
UR - http://www.scopus.com/inward/record.url?scp=0034022833&partnerID=8YFLogxK
U2 - 10.1093/ndt/15.6.883
DO - 10.1093/ndt/15.6.883
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C2 - 10831646
AN - SCOPUS:0034022833
SN - 0931-0509
VL - 15
SP - 883
EP - 887
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 6
ER -