In end-stage renal disease patients the leading causes of mortality are of cardiovascular origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. Notwithstanding, a contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to its progression to end-stage renal disease and is further accelerated by renal replacement therapies. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring, electron donating antioxidant defense systems. Renal replacement therapies such as hemodialysis and peritoneal dialysis, aggravate oxidative stress by the procedures per se. A close association of oxidative stress with accelerated atherosclerosis and increased risk for cardiovascular and all-cause mortality has been described. Especially lipid peroxidation has been identified which triggers endothelial dysfunction as a first step in atherogenesis. To counteract the deleterious effects of free radicals and thereby ameliorate or retard cardiovascular disease exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing outcome data from studies that test antioxidants, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.
Keywords: Antioxidants, cardiovascular disease, end-stage renal disease, hemodialysis, N-acetylcysteine, oxidative stress, peritoneal dialysis
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