Hemodialysis causes antioxidant loss leading to

long-term complications

Oxidative stress, an imbalance between toxic compounds and defense

mechanisms, and prevalent in the dialysis process, has been linked to
numerous adverse complications in end-stage renal disease (ESRD) patients.
The imbalance is caused by the overproduction of reactive oxygen species
(ROS), or toxic compounds, and lack of antioxidants to fight these toxins. In
fact, the hemodialysis process can cause loss of these necessary antioxidants.

Many ESRD and hemodialysis patients are in a state of chronic

inflammation induced by the dialysis process which further enhances
oxidative stress. This state is strongly associated with long-term
complications such as cardiovascular disease, malnutrition, poor outcome
and low survival.

"It is important to prevent reactive oxygen species production by improving

the biocompatibility of the hemodialysis system," states Dr. Jean-Paul
Cristol, corresponding author. Antioxidant supplementation and ROS
modulation by specific or non-specific drugs, such as statins, are possible
solutions outlined in the article.

"Correction of OS imbalance appears to be a basic requisite to prevent

complications in long-term dialysis patients" and is "a promising avenue of
research."
 Repeat Peritonitis in Peritoneal Dialysis:
Retrospective Review of 181 Consecutive Cases
Background and objectives: The clinical behavior of repeat-peritonitis
episodes, defined as peritonitis with the same organism occurring more than
4 weeks after completion of therapy for a prior episode, is poorly
understood. Design, setting, participants, & measurements: We compared
outcomes of 181 episodes of repeat peritonitis from 1995 to 2009 (Repeat
Group) with 91 episodes of relapsing peritonitis (Relapsing Group) and 125
episodes of peritonitis preceded 4 weeks or longer by another episode with a
different organism (Control Group).

Results: In Repeat Group, 24% were due to Staphylococcus aureus, as

compared with 5.5% in Relapsing Group and 15% in Control Group. The
majority of the organisms causing relapsing peritonitis were Gram negative
(62%), whereas the majority of that in Repeat Group were Gram positive
(56%). Repeat Group had a lower complete-cure rate (70.7% versus 54.9%)
than Relapsing Group, but rates of primary response, catheter removal, and
mortality were similar. Repeat Group had a higher primary response rate
(89.0% versus 73.6%) and a lower rate of catheter removal (6.1% versus
15.2%) than Control Group, whereas the complete-cure rate and mortality
were similar. Repeat Group had a higher risk of developing relapsing (14.3%
versus 2.2%) and repeat peritonitis (26.1% versus 5.4%) than Control
Group, whereas the risk of recurrent peritonitis was similar.

Conclusions: Repeat peritonitis is a distinct clinical entity. Although repeat-

peritonitis episodes generally have a satisfactory response to antibiotic, they
have a substantial risk of developing further relapsing or repeat peritonitis.

• Received June 22, 2010.

• Accepted November 26, 2010.