Evaluation of relationship between hemoglobin variability and oxidative stress and inflammation in chronic renal failure

Cardiovascular diseases are the most important cause of mortality and morbidity in chronic renal failure. Anemia frequently seen in these patients is one of the most important cause of mortality and morbidity. Besides anemia, hemoglobin (Hg) variability also causes increase in morbidity, hospitalization and mortality. However, this mechanism cannot be explained yet.Relation between cardiovascular disease and oxidative stress and inflammation is described in uremic patients. Moreover, increase in oxidative stress and inflammation is known as one of the most important cause of hemoglobin variability. While these abnormalities causing hemoglobin variability, it?s likely to be related with increase in mortality and morbidity in these patients. In this context, to study levels of pro-oxidant (myeloperoxidase (MPO)), nitrotirosine (NTY), anti-oxidant (total anti-oxidant capacity (TAK)), inflammation (interleukin (IL-6, Hs-CRP)), procoagulant (Plasminogen activator inhibitor type 1 (PAI-1) activity) is planned in patients with variable hemoglobin levels.In light of the studies done on this subject, hemodialysis patients (n=114) broke down into different six groups according to Hg levels in last 6 months. Furthermore, a suitable control group (n=30) is composed according to acceptable demographic and clinical properties.Groups are described as group 1 (n=10); patients with Hg levels always less than 11 gr/dl, group 2 (n=32); patients with Hg levels sometimes between 11-12 gr/dl and sometimes less than 11 gr/dl (group shows variability close to inferior limit), group 3 (n=19); patients with Hg levels between 11-12 gr/dl, group 4 (n=15); patients with Hg levels sometimes between 11-12 gr/dl sometimes more than 12 gr/dl (group shows variability close to superior limit), group 5 (n=26); patients with Hg levels are wide-variable and group 6 (n=12); patients with Hg levels always more than 12 gr/dl.Avarage levels of pro-oxidant (MPO, NTY) (p<0.005), inflammation (IL-6, Hs-CRP) (p<0.01) and procoagulant (PAI-1 activity) (p<0.005) are higher than control group however, levels of anti-oxidant (TAK) (p<0.01) are lower than control group. Pro-oxidant, inflammation and procoagulant activity levels are highest in group 1 (anemic) and least in group 6 (Hg >12 gr/dl) (p<0.005). TAK is least in anemic group and highest in Hg normal group. Stable group (group 3) that Hg levels between 11-12 gr/dl is the most alike the normal Hg group (group 6) that is known as having least mortality and morbidity in terms of these parameters. Group 5 (patients with great fluctuations) is the most alike group 1 (patients with anemia) that is known as having highest mortality and morbidity in terms of these parameters. In all groups, there is no corelation between these parameters and erythropoetin and iron dosage (p>0.05).Oxidative stres, increased inflammation and procoagulant activity is related with cardiovascular mortality and morbidity in uremic patients, in recent studies, these parameters are shown as increased mortality and morbidity in patients with great variable Hg levels and so this shows a possible pathogenetic relationship. To clear this subject, prospective studies with longer follow-up are needed.