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Abstract
The annual mortality rate in dialysis patients remains high despite the marked improvement in dialysis technology and patient care. Atherosclerosis is the major cause of morbidity and mortality in patients with end stage renal disease. This study evaluated non-traditional risk factors of atherosclerosis in patients with chronic kidney disease. Sulfur containing amino acids (Met and cys.) and their metabolites (Hcy, Tau and pl. GSH), interleukins (IL-1? and IL-6), MDA, AOPPs and antioxidants (pl. GSHPx and E. GSHPx, vitamin E and vitamin C). Subjects included 20 nondialysed CKD patients, 20 HD patients together with 20 healthy subjects. Fasting blood samples were drowning. Another blood sample was drowning from HD patients after single dialysis session. Our results showed that, in comparison with the control group, plasma cystine, Cys and Hcy were highly significantly increased in CKD and pre-HD groups. No significant change in plasma Met and Tau in CKD group but significantly reduced in pre-HD group. Plasma GSH was significantly decreased in CKD and pre-HD groups. After dialysis session, the plasma levels of cystine, cys, Hcy, Met and Tau were significantly decreased. Plasma IL- 1? and IL-6, MDA and AOPPs were significantly elevated in all patient groups. Pl. GSHPx and vitamin C levels were highly significantly decreased in all patient groups. Vitamin E and E-GSHPx showed no significant change in CKD and pre-HD groups but vit. E significantly decreased after dialysis.
In conclusion, Patients with CKD on either conservative or HD treatment suffer from alterations in metabolism of sulfur containing amino acids, which increase the homocysteine levels, one of the independent risk factors of atherosclerosis, depletion of plasma antioxidants and increasing of pro-inflammatory cytokines. All of these processes accelerate the progression of atherosclerosis.