Zusammenfassung
Patienten unter chronischer Hämodialyse zeigen eine um das Vielfache erhöhte kardiovaskuläre Morbidität und Mortalität. Diese kardiovaskulären Komplikationen lassen sich nur unzureichend durch traditionelle und urämiebedingte Risikofaktoren, wie Dys- und Hyperlipidämie, Hypertonie, Hyperhomozysteinämie, Hyperphosphatämie und Hypoalbuminämie erklären. Oxidativer Stress, Malnutrition und Inflammation scheinen die wichtigeren Determinanten für die kardiovaskuläre Morbidität und Mortalität zu sein. Oxidativer Stress entsteht bei Dialysepatienten bereits infolge der Primärerkrankung (Niereninsuffizienz) und wird durch die Dialysebehandlung selbst und die dadurch veränderte Stoffwechselsituation noch verstärkt. Der oxidative Stress trifft dabei auf häufig verminderte Konzentrationen antioxidativ wirksamer Substanzen. Infolge dessen besteht bei Dialysepatienten ein Ungleichgewicht zwischen oxidativen und antioxidativen Faktoren (oxidative > antioxidative). Die oxidativen Schädigungen an den Makromolekülen, wie Lipiden, Proteinen und der DNA können anhand verschiedener Biomarker nachgewiesen werden. Durch die Supplementierung mit Antioxidanzien (vorrangig Vitamin E) und den Einsatz biokompatibler, mit Vitamin-E-beschichteter Dialysemembranen wird das Ausmaß oxidativer Schädigungen vermindert.
Abstract
Chronic hemodialysis patients have an increased cardiovascular morbidity and mortality. The cardiovascular complications can only be in part explained by uremia caused cardiovascular risk factors like dys- and hyperlipidemia, hypertension, hyperhomocysteinemia, hyperphosphatemia and hypoalbuminemia. Oxidative stress, malnutrition and inflammation seem to be major determinants of cardiovascular morbidity and mortality. Chronic hemodialysis patients have oxidative stress as a result of the primary disease, dialysis itself as well as of altered metabolism. Oxidative stress is accompanied by lower serum levels of antioxidants. As a consequence there is an imbalance between oxidative and antioxidative factors (oxidative > antioxidative). Oxidative modifications on macromolecules like lipids, proteins and the DNA can be assessed by different biomarkers. Supplementation of antioxidants (tocopherols) and the use of biocompatible and vitamin E coated dialysis membrans can decrease oxidative modifications.
Schlüsselwörter
Niereninsuffizienz - oxidativer Stress - Biomarker - Hämodialyse
Key words
Kidney disease - oxidative stress - biomarker - hemodialysis
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1943-1950
Prof. Dr. Manfred James Müller
Christian-Albrechts-Universität zu Kiel · Institut für Humanernährung und Lebensmittelkunde
Düsternbrooker Weg 17 - 19
24105 Kiel
Email: mmueller@nutrfoodsc.uni-kiel.de
