Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Original Communication

Vitamin E supplementation in chronically hemodialyzed patients – influence on blood hemoglobin and plasma (anti)oxidant status

Published Online:February 27, 2019https://doi.org/10.1024/0300-9831/a000471

Abstract

Abstract.Background: Disturbed oxidant/antioxidant status is involved in pathogenesis of anemia in end stage renal disease. There is evidence that vitamin E supplementation can increase blood hemoglobin in chronically hemodialyzed patients. However, the interindividual variation in response to the supplementation has not been fully addressed. Methods: 24 chronically hemodialyzed patients were supplemented with vitamin E (400 IU/day) in a period of two months. They had already been treated with erythropoiesis stimulating agents (ESA) and iron on a long-term basis, which was continued during the study period. A group of 20 healthy volunteers served as control subjects. Complete blood count, general biochemistry assays, the redox status by total thiols, oxidative stress by reactive oxygen metabolites, antioxidant status by biological antioxidant potential, and vitamin E (α- and γ- tocopherol) were measured before the start of supplementation, one month and two months later. Results: Overall, the vitamin E supplementation did not cause an increase of blood hemoglobin, hematocrit or red blood cells. However, 50 % of the patients with basal blood hemoglobin below 12.0 g/dL (N = 10) responded to the supplementation with its continuous increase. In addition, vitamin E exhibited a slight prooxidant effect only in the subgroup of patients with basal blood hemoglobin of ≥ 12.0 g/dL, two months after the start of supplementation (decreased total thiols: 300 ± 31 vs. 277 ± 36 µmol/L, p < 0.05; increased reactive oxygen metabolites: 183 ± 140 vs. 287 ± 112 CARR U, p > 0.05; decreased biological antioxidant potential: 2278 ± 150 vs. 2171 ± 126 µEq/L, p < 0.025), which coincided with their significantly increased serum α-tocopherol concentrations in comparison to the patients with basal blood hemoglobin below 12.0 g/dL (41.3 ± 7.2 vs. 59.9 ± 19.2 µmol/L, p < 0.025). Conclusions: When treated with ESA and iron on a long-term basis, the response to the vitamin E supplementation in chronically hemodialyzed patients is largely dependent on their basal blood hemoglobin and serum vitamin E concentrations.

Literature

  • Del Vecchio, L., Locatelli, F. and Carini, M. (2011) What we know about oxidative stress in patients with chronic kidney disease on dialysis--clinical effects, potential treatment, and prevention. Semin Dial. 24, 56–64. First citation in articleCrossref, Google Scholar

  • Bjelakovic, G., Nikolova, D. and Gluud, C. (2013) Meta-regression analyses, meta-analyses, and trial sequential analyses of the effects of supplementation with beta-carotene, vitamin A, and vitamin E singly or in different combinations on all-cause mortality: do we have evidence for lack of harm? PLoS One. 8:e74558. First citation in articleCrossref, Google Scholar

  • Jun, M., Venkataraman, V., Razavian, M., Cooper, B., Zoungas, S., Ninomiya, T., Webster, A. C. and Perkovic, V. (2012) Antioxidants for chronic kidney disease. Cochrane Database Syst Rev. 10:CD008176. First citation in articleCrossref, Google Scholar

  • Coombes, J. S. and Fassett, R. G. (2012) Antioxidant therapy in hemodialysis patients: a systematic review. Kidney Int. 81, 233–246. First citation in articleCrossref, Google Scholar

  • Daud, Z. A., Tubie, B., Sheyman, M., Osia, R., Adams, J., Tubie, S. And Khosla, P. (2013) Vitamin E tocotrienol supplementation improves lipid profiles in chronic hemodialysis patients. Vasc Health Risk Manag. 9, 747–761. First citation in articleGoogle Scholar

  • Baldi, S., Innocenti, M., Frascerra, S., Nannipieri, M., Lippi, A., Rindi, P. and Ferrannini, E. (2013) Effects of hemodialysis and vitamin E supplementation on low-density lipoprotein oxidizability in end-stage renal failure. J Nephrol. 26, 549–555. First citation in articleCrossref, Google Scholar

  • Tayebi Khosroshahi, H., Habibi Asl, B., Habibzadeh, A., Chaichi, P., Ghanbarpour, A. and Hossein Badie, A. (2013) Comparison of vitamin e and L-carnitine, separately or in combination in patients with intradialytic complications. Nephrourol Mon. 5, 862–865. First citation in articleCrossref, Google Scholar

  • Roozbeh, J., Shahriyari, B., Akmali, M., Vessal, G., Pakfetrat, M., Raees Jalali, G. A., Afshariani, R., Hasheminasab, M. and Ghahramani, N. (2011) Comparative effects of silymarin and vitamin E supplementation on oxidative stress markers, and hemoglobin levels among patients on hemodialysis. Ren Fail. 33, 118–123. First citation in articleCrossref, Google Scholar

  • Del Vecchio, L. and Locatelli, F. (2014) Anemia in chronic kidney disease patients: treatment recommendations and emerging therapies. Expert Rev Hematol. 7, 495–506. First citation in articleCrossref, Google Scholar

  • Ruskovska, T., Bennett, S. J., Brown, C. R., Dimitrov, S., Kamcev, N. and Griffiths, H. R. (2015) Ankyrin is the major oxidised protein in erythrocyte membranes from end-stage renal disease patients on chronic haemodialysis and oxidation is decreased by dialysis and vitamin C supplementation. Free Radic Res. 49, 175–185. First citation in articleCrossref, Google Scholar

  • Rusu, A., Rusu, F., Zalutchi, D., Muresan, A., Gherman Caprioara, M. and Kacso, I. (2013) The influence of vitamin E supplementation on erythropoietin responsiveness in chronic hemodialysis patients with low levels of erythrocyte superoxide dismutase. Int Urol Nephrol. 45, 495–501. First citation in articleCrossref, Google Scholar

  • Locatelli, F., Bárány, P., Covic, A., De Francisco, A., Del Vecchio, L., Goldsmith, D., Hörl, W., London, G., Vanholder, R. and Van Biesen, W. ERA-EDTA ERBP Advisory Board. (2013) Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrol Dial Transplant. 28, 1346–1359. First citation in articleCrossref, Google Scholar

  • European Best Practice Guidelines on Haemodialysis (Part 2), Nephrol Dial Transplant. Vol. 22, Supplement 2, May 2007. First citation in articleGoogle Scholar

  • Jilani, T., Azam, I., Moiz, B., Mehboobali, N. And Perwaiz Iqbal, M. (2015) Positive Association of Vitamin E Supplementation with Hemoglobin Levels in Mildly Anemic Healthy Pakistani Adults. Int J Vitam Nutr Res. 85, 39–49. First citation in articleLink, Google Scholar

  • Kalantar-Zadeh, K. and Aronoff, G. R. (2009) Hemoglobin variability in anemia of chronic kidney disease. J Am Soc Nephrol. 20, 479–487. First citation in articleCrossref, Google Scholar

  • Kontush, A., Finckh, B., Karten, B., Kohlschütter, A. and Beisiegel, U. (1996) Antioxidant and prooxidant activity of alpha-tocopherol in human plasma and low density lipoprotein. J Lipid Res. 37, 1436–1448. First citation in articleCrossref, Google Scholar

  • Antoniadi, G., Eleftheriadis, T., Liakopoulos, V., Kakasi, E., Kartsios, C., Passadakis, P. and Vargemezis, V. (2008) Effect of one-year oral alpha-tocopherol administration on the antioxidant defense system in hemodialysis patients. Ther Apher Dial. 12, 237–242. First citation in articleGoogle Scholar

  • Handelman, G. J. (2007) Vitamin C deficiency in dialysis patients--are we perceiving the tip of an iceberg? Nephrol Dial Transplant. 22, 328–331. First citation in articleGoogle Scholar

  • Schöttker, B., Saum, K. U., Jansen, E. H., Boffetta, P., Trichopoulou, A., Holleczek, B., Dieffenbach, A. K. and Brenner, H. (2015) Oxidative stress markers and all-cause mortality at older age: a population-based cohort study. J Gerontol A Biol Sci Med Sci. 70, 518–524. First citation in articleGoogle Scholar

  • Saum, K. U., Dieffenbach, A. K., Jansen, E. H., Schöttker, B., Holleczek, B., Hauer, K. and Brenner, H. (2015) Association between Oxidative Stress and Frailty in an Elderly German Population: Results from the ESTHER Cohort Study. Gerontology. 61, 407–415. First citation in articleCrossref, Google Scholar

  • Ruskovska, T., Jansen, E. H. and Antarorov, R. (2014) Evaluation of assays for measurement of serum (anti)oxidants in hemodialysis patients. Biomed Res Int. 2014:843157. First citation in articleCrossref, Google Scholar

  • Eleftheriadis, T., Antoniadi, G., Liakopoulos, V. and Stefanidis I. (2010) Alpha-tocopherol administration decreases serum urate levels in hemodialysis patients. Ther Apher Dial. 14, 605–606. First citation in articleCrossref, Google Scholar

  • Aleksandrova, K., Jenab, M., Bueno-de-Mesquita, H. B., Fedirko, V., Kaaks, R., Lukanova, A., van Duijnhoven, F. J., Jansen, E., Rinaldi, S., Romieu, I., Ferrari, P., Murphy, N., Gunter, M. J., Riboli, E., Westhpal, S., Overvad, K., Tjønneland, A., Halkjær, J., Boutron-Ruault, M. C., Dossus, L., Racine, A., Trichopoulou, A., Bamia, C., Orfanos, P., Agnoli, C., Palli, D., Panico, S., Tumino, R., Vineis, P., Peeters, P. H., Duell, E. J., Molina-Montes, E., Quirós, J. R., Dorronsoro, M., Chirlaque, M. D., Barricarte, A., Ljuslinder, I., Palmqvist, R., Travis, R. C., Khaw, K. T., Wareham, N., Pischon, T. and Boeing, H. (2014) Biomarker patterns of inflammatory and metabolic pathways are associated with risk of colorectal cancer: results from the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Epidemiology. 29, 261–275. First citation in articleCrossref, Google Scholar

  • Schöttker, B., Zhang, Y., Heiss, J. A., Butterbach, K., Jansen, E. H., Bewerunge-Hudler, M., Saum, K. U., Holleczek, B. and Brenner H. (2015) Discovery of a novel epigenetic cancer marker related to the oxidative status of human blood. Genes Chromosomes Cancer. 54, 583–594. First citation in articleGoogle Scholar

  • Willers, J., Heinemann, M., Bitterlich. N. and Hahn, A. (2014) Vitamin Intake from Food Supplements in a German Cohort – Is there a Risk of Excessive Intake? Int J Vitam Nutr Res. 84, 152–162. First citation in articleGoogle Scholar

  • Abed, M., Artunc, F., Alzoubi, K., Honisch, S., Baumann, D., Föller, M. and Lang, F. (2014) Suicidal erythrocyte death in end-stage renal disease. J Mol Med (Berl). 92, 871–879. First citation in articleCrossref, Google Scholar

  • Tonon, J., Guarnier, F. A., Cecchini, A. L. and Cecchini, R. (2012) Anemia associated with extraerythrocytic oxidative stress damage mediated by neutrophil superoxide anion production in chronic renal failure patients undergoing hemodialysis. Pathophysiology. 19, 261–168. First citation in articleCrossref, Google Scholar

  • Hsu, S. P., Chiang, C. K., Yang, S. Y. and Chien, C. T. (2010) N-acetylcysteine for the management of anemia and oxidative stress in hemodialysis patients. Nephron Clin Pract. 116, 207–216. First citation in articleCrossref, Google Scholar

  • Rivara, M. B., Ikizler, T. A., Ellis, C. D., Mehrotra, R. and Himmelfarb, J. (2015) Association of plasma F2-isoprostanes and isofurans concentrations with erythropoiesis-stimulating agent resistance in maintenance hemodialysis patients. BMC Nephrol. 16, 79. First citation in articleCrossref, Google Scholar