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Background and aims. Cardiovascular (CV) disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients. Kidney disease is associated with increased oxidative stress (OS), a nontraditional CV risk factor. Few studies evaluate the effect of OS markers on CV events (CVE) and survival in HD patients. The aim of this study is to examine potential determinants of OS markers and their predictive role on survival and CV morbidity and mortality in HD patients during a long-term follow-up (108 months). Methods. We conducted an analytical cross-sectional prospective observational study, carried on a cohort of randomly selected HD patients. We registered in 44 HD patients baseline characteristics, OS markers, mortality and CVE over a period of 108 months and we used statistical analysis (descriptive, Kaplan-Meier, univariate and multivariate Cox model) for interpretation. Results. Bound malondialdehyde (bMDA) was positively correlated with serum calcium, protein carbonyls (PC) were inversely correlated with diastolic blood pressure (DBP) and directly correlated with ferritin, NOx was directly correlated with ceruloplasmin) and serum albumin. Of the measured OS markers only bMDA was related to survival (HR=3.29 95% CI (1.28-8.44), p=0.01), and approached statistical significance in the effect on CV mortality (HR=2.85 95% CI (0.88-9.22), p=0.07). None of the measured OS markers was associated with CVE. Conclusions. bMDA has a strong predictive value on survival in HD patients in a long-term follow-up (9 years). Its value is correlated with CV mortality but is not a predictor of CV events. Regular assessment of MDA in HD patients and the development of strategies aimed at reducing oxidative stress in these patients might be beneficial. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular morbidity is the first factor that influences survival in chronically hemodialyzed patients. For this reason a permanent evaluation of cardiovascular risk and of efficient therapeutic methods are necessary This study followed the cardiovascular events and deceased frequency in chronically hemodialyzed patients under ACEI and beta-blocker therapy, in our region. We also followed, the effects of these therapies on some cardiovascular risk factors and on plasma potassium and we registered the use frequency of the study medication in the chronically hemodialyzed patients. Metods: 106 chronically hemodialyzed patients were investigated; among these 58 patients were selected, under beta-blocker±ACEI therapy. Two groups were formed: group A: 36 patients under beta-blocker therapy and group B: 22 patients under ACEI and beta-blocker therapy. Clinical and biological data were also recorded when the study started, including diabetes mellitus, cardiovascular history, some cardiovascular risk factors. Taking into consideration the age, sex, diabetes mellitus and cardiovascular history presence, we formed the subgroups. We followed the groups for 24 month and we noted the deceased and the cardiovascular events frequency: angina pectoris, including acute myocardial infarction, peripheral arterial disease events, stroke. We analyzed the groups and subgroups by comparison. Results: The frequency use of ACEI therapy was not frequent: 20,75%. No significant differences in the frequency of CE, or deceased number, were found between the groups and subgroups with and without ACEI therapy. Among the monitored cardiovascular risk factors, only SBP was lower and the serum albumin levels was higher in patients under association ACEI betablokers therapy (p=0,05 for SBP and p=0,08 for serum albumin, if mean values were compared between groups A and B, respectively p=0,02 for SBP and p=0,05 for serum albumin if mean values was compared between subgroup older than 50 years). The mean value of serum potassium did not reach dangerous levels in either group, and there were no significant differences between two groups Conclusion: The therapeutic beta-blockers-ACEI association was rarely use in our chronically hemodialyzed patients. Even if this therapeutic association didn`t significantly reduce the cardiovascular events and deceased number, in that period, when we compared it with isolated betablokers use, it significantly decreased BP, and it was associated with a higher serum albumin. The mean value of serum potassium was not significantly modified in ACEI beta-blokers association groups. [ABSTRACT FROM AUTHOR]