Elevated plasma F2-isoprostanes in patients on long-term hemodialysis

Background. End-stage renal disease (ESRD) patients on long term hemodialysis (HD) may be under increased oxidative stress, caused by either HE or renal failure. Plasma F2-isoprostanes have been established as an important indicator of in vivo oxidative stress. Methods. Plasma esterified F2-isoprostanes were measured in 25 KD patients and 23 controls with normal renal function, employing gas chromatography-mass spectrometry with negative chemical ionization (GC-MS-NCI). C-reactive protein (CRP) was determined concurrently in patients and controls by enzyme-linked immunosorbent assay (ELISA). alpha -Tocopherol. retinol, albumin and creatinine were also determined. Results. The average total esterified F2-isoprostanes in the ESRD patients was 1.62 +/- 0.73 vs. 0.27 +/- 0.10 ng/mL in controls (P < 0.001), with no overlap between patients and controls. Plasma F2-isoprostanes in diabetic ESRD patients were similar to F2-isoprostanes in patients with other causes for renal failure, In a subset of 10 of these ESRD patients evaluated eight months after the initial measurement. plasma-esterified F2-isoprostanes were not altered by an individual dialysis session. Average plasma CRP values were also higher in HD patients (P < 0.02). but some patients had CRP values that were similar to controls. In the I-ID patients, total plasma F2-isoprostanes and plasma CRP were correlated (I = 0.48, P = 0.015). Plasma cw-tocopherol did not differ between patients and controls, but plasma retinol was higher in patients (3.15 +/- 1.71 mu mol/L) than in controls (1.97 +/- 0.51 mu mol/L, P < 0.05). Conclusions. These results are consistent with the hypothesis that oxidative stress in ESRD patients contributes to increased values of esterified plasma F2-isoprostanes, with concurrent increases in plasma CRP levels in some patients. Impaired clearance of esterified F2-isoprostanes may contribute to the elevated levels in renal failure. Plasma esterified F2-isoprostanes may be a useful indicator to evaluate effectiveness of interventions to decrease oxidative stress and associated inflammation.