Influence of Oxidative Stress and Inflammation on rHuEPO Requirements of Hemodialysis Patients With CRP Values “in Normal Range”

AimsWe sought to evaluate influences of oxidative stress (OS) on rHuEPO requirements in hemodialysis patients without chronic inflammation.MethodsSixty-eight hemodialysis patients and 46 healthy controls underwent measurements plasma levels of antioxidative agents, such as glutathione peroxidase (GPX), superoxide dismutase (SOD), and oxidative compounds including malonyldialdehyde (MDA). We retrospectively analyzed the last 3 months’ rHuEPO requirements, iron indices, and CRP levels.ResultsPlasma levels for SOD, GPX, and MDA were 974.4 ± 216.4 U/gHb, 44.4 ± 13.6 U/gHb, 10.0 ± 2.0 nmol/mL, respectively yielding results that were different from healthy controls (P < .0001). Increased OS negatively correlated with hemoglobin levels (P < .0001) and positively correlated with rHuEPO requirements (P < .01). Increased antioxidative capacity positively correlated with hemoglobin levels (P < .0001) and negatively correlated with rHuEPO requirements (P < .0001). For further analyses, hemodialysis patients were subgrouped according to rHuEPO requirements as group I (lowest 1/3, n = 23), group II (moderate 1/3, n = 23) and group III (highest 1/3, n = 22). Group III displayed the highest MDA (P < .05), the lowest SOD (P < .0001), and comparable GPX (P < .05) levels. Group III also had the highest CRP and the lowest albumin levels compared with the others (P < .01).ConclusionOS has strong adverse influences on rHuEPO responses of HD patients with “normal” CRP levels, but it should not be forgotten that CRP levels in the “normal” range may still reflect ongoing microinflammation.