Abstract

Objective: Anemia is common in (End stage renal disease) ESRD patients. Oxidative stress exacerbate anemia. we aim to assess the impact of hemodialysis (HD) procedure on red cell antioxidant enzymes. Methods: A controlled trial involving 30 HD patients and 30 controls; blood samples were taken pre- and post-HD for assessment of red cell glutathione peroxidase (GSH-Px) and reductase (GSH-Rx). Results: Post-HD; GSH-Px, GSH-Rx were significantly reduced compared to both Pre-HD and control group (P<0.001) respectively . Patients on erythropoietin and iron therapy had significant higher GSH-Px enzyme compared to patients on iron therapy GSH-Px had significant inverse correlation versus serum creatinine and urea and positive correlation with Hct and total protein. Regression analysi s showed that HD therapy duration (P<0.001), BMI (P = 0.004), serum urea, creatinine, Hct, and total proteins (P<0.001) are significant factors affecting red cell GSH-Px; whereas serum creatinine, urea, neutrophils count, total proteins (P<0.001) and red cell parameter MCV (P = 0.002) and Hct (P = 0.04) are significant factors affecting red cell GSH-Rx. Receiver operator characteristic (ROC) curve for GSH-Px and GSH-Rx cut off point which discriminate between HD patients and normal control is (86) and (69) (nmol/min/ml) respectively with 100% sensitivity and specificity. Area under the curve is 1.0. Conclusion: Mechanical stress during extracorporeal circulation in the dialysis machine aggravates red cell oxidative damage. Therefore it is suggested to suppl ement erythropoietin together with antioxidant as they may be capable of recovering antioxidant defense in HD patients.