The effects of strict volume control on cognitive functions, markers of oxidative stress and inflammation in chronic hemodialysis patients

Introduction: Chronic renal failure is usually needed to hemodialysistreatment. Cardiovascular disease is the major cause of death in dialysis patients.Left ventricular hypertrophy, which developes as a result of hypertension andhypervolemia, one of the cause of mortality in patient with chronic renal failure.Hypervolemic hypertension is common in hemodialysis patients and leftventricular hypertrophy ussually develops if it is treated by antihypertensive drugswithout establishing normovolemia. In this study, our aim was to evaluate theeffect of strict volume control on cognitive functions, oxidative stress andinflammation markers in hemodialysis patients.Material and Method: The study was composed of groups; strict volumecontrol with normotensive hemodialysis patients (n= 22), antihypertensive drugswith normotensive hemodialysis patients (n= 24) and healthy control (n= 20). Thestudy was started when blood pressures were reached acceptable range at the endof six month follow up period. Echocardiography and P300 recordings which wasused in cognitive evaluation of patient groups was done in short interdialytic day.MDA, SOD, GSH-Px, ok-LDL, NO, CRP, TNF-α, IL-1, IL-6 and routinebiochemical parameters were studied in all patients.Results: Although the interdialytic weight gain of the hemodialysispatients using antihypertensive drugs was higher than hemodialysis patientsapplied strict volume control (p<0.001), blood pressure of the drug users waswithin the acceptable levels. Echocardiographic parameters such as KTI, EF,LVMI and LVEDI were significantly lower in strict volume control group(p<0.05). Although P300 latency and amplitudes were better in strict volumecontrol group, it was not reached statistical significance. Oxidative stress andinflammation markers were also significantly lower in strict volume control groupthan antihypertensive drug group. Anti-oxidant system was protected better instrict volume control group. NO levels were similar in both groups.Conclusion: Strict volume control instead of antihypertensive drugsprotects cardiac functions better, exposes patients to less oxidative stres andinflammation, and positive effect on cognitive functions partially in hemodialysispatients.Key words: Hemodialysis, Strict volume control, Cognitive functions,Oxidative stress, Inflamattion