Haemodialysis and Oxidant Stress
The aim of this book is to provide new insight into the role of oxidant stress in the progression of chronic renal disease and the pathogenesis of the co-morbidities associated with dialysis. Oxidative stress may arise from several sources in the chronically diseased kidney, including infiltrating cells, endogenous renal cells, proteinuric states and metabolic adaptations in surviving nephrons. This chronic exposure to inappropriate free radical production can cause low-densitylipoprotein oxidation, cell membrane modification, protein cross-linking and damage to DNA, which, in turn, are related to many of the co-morbidities associated with dialysis such as amyloidosis and atherosclerosis, nutrition anaemia and infection. Oxidative stress may also be caused by chronic haemodialysis: The use of a bioincompatible dialysis system results in a dramatic increase in the production of reactive oxygen species, thus reducing antioxidant defence mechanisms. Possible solutions to this problem are discussed here: there is both clinical and experimental evidence that oxidant stress can be prevented, or at least reduced, by using an antioxidant dialysate, vitamin-E-modified membranes or by increased dietary intake of antioxidants. Very recently, a new approach has been proposed in this context, namely haemolipodialysis, consisting of dialysate containing ascorbic acid and vitamin-E-containing liposomes. This publication will be of special interest to nephrologists, bioengineers and biomaterial scientists involved in extracorporeal therapies such as haemodialysis and apheresis.