Antioxidant therapy in hemodialysis patients: A systematic review

Coombes, Jeff S. and Fassett, Robert G. (2012) Antioxidant therapy in hemodialysis patients: A systematic review. Kidney International, 81 3: 233-246. doi:10.1038/ki.2011.341

Author Coombes, Jeff S.
Fassett, Robert G.
Title Antioxidant therapy in hemodialysis patients: A systematic review
Journal name Kidney International   Check publisher's open access policy
ISSN 0085-2538
Publication date 2012-02-01
Year available 2011
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1038/ki.2011.341
Volume 81
Issue 3
Start page 233
End page 246
Total pages 14
Place of publication London, United Kingdom
Publisher Nature Publishing Group
Collection year 2012
Language eng
Formatted abstract
Antioxidants have been used as therapies to decrease oxidative stress and improve CVD risk in hemodialysis (HD) patients. A systematic search of the Medline database (search date 30 April 2011) found 56 studies investigating the effects of antioxidant therapies on biomarkers of oxidative stress (53 studies) or clinical outcomes (3 studies). The majority were small trials using a nonrandomized open-label design with a single HD group (no HD controls). Alpha-tocopherol was the most investigated antioxidant, with 20/25 studies reporting that this vitamin decreased oxidative stress, and one clinical outcome trial in 196 patients finding that it protected against secondary CVD. Studies using vitamin C were more equivocal, with 4/11 showing decreased oxidative stress and one clinical outcome trial showing no effect on morbidity or mortality. N-acetylcysteine was the most efficacious agent, with 4/4 studies indicating a decrease in oxidative stress and one trial (n=134) showing reduced CVD events. Seven studies have used therapy containing a combination of antioxidants, with five of these reporting decreased oxidative stress. Most intervention studies in HD patients, such as statin therapy and increased dialysis dose, have failed to show improvement in CVD outcomes. Two intervention trials using different antioxidants have found CVD benefits, suggesting that this line of therapy is effective in this resistant population. These studies require validation in larger, adequately powered trials.
Keyword ESRD
Oxidative stress
Vitamin C
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online 5 October 2011

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 37 times in Thomson Reuters Web of Science Article | Citations
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Created: Fri, 28 Oct 2011, 09:44:57 EST by Matthew Lamb on behalf of School of Medicine