The relationship between hemoglobin variability and oxidative stress and inflammation in CKD

DOI: 10.4328/JCAM.5912 Received: 26.05.2018 Accepted: 09.06.2018 Published Online: 10.06.2018 Printed: 01.01.2019 J Clin Anal Med 2019;10(1): 20-5 Corresponding Author: Tulay Kus, Department of Medical Oncology, Adıyaman University, Training and Research Hospital, TR-02040, Adıyaman, Turkey. T.: +90 4162161015 F.: +90 4162161014 E-Mail: drtulaykus83@hotmail.com Abstract Aim: Hemoglobin (Hg) variability, which is frequently seen in patients with chronic kidney disease (CKD) who undergo dialysis, has been shown to be associated with increased mortality and cardiovascular disease (CVD) , but its mechanism remains unclear. Increased oxidative stress and inflammation with uremia lead to the development of anemia. In this context, we aimed to investigate the relationship between Hb variability and oxidative stress and inflammation. Material and Method: The data of 114 patients followed by dialysis service of Gaziantep University were included in this study retrospectively. Myeloperoxidase (MPO), nitrotyrosine (NTY), total antioxidant capacity (TAC), interleukin-6 (IL-6), Hs-CRP, and plasminogen activator inhibitor-1(PAI-1) levels of the patients whom we divided into 6 groups according to their Hg variability were measured. A control group (n = 30) was also formed demographically and clinically appropriate to this group. Results: The mean MPO, NTY, IL-6, Hs-CRP, and PAI-1 levels were higher in the dialysis patients than in the control group, whereas TAC levels were lower. Prooxidant, inflammation and procoagulant activity levels were lower in the Group 6 (Hg>12) and the Group 3 (stable, Hg=11-12 gr/dl) but higher in wide Hg variable group (Group 5) and Group 1 (Hg <12 gr/dl). Discussion: Oxidative stress, inflammation, and procoagulant activity, which are associated with higher CVD and mortality were found to be high in wide Hg variable and anemic groups in patients who underwent dialysis. The present study has a valuable finding in terms of elucidating the possible mechanism of increased mortality in patients with wide variable Hg course.