Patients hypervolemic ultrafiltration diuretic therapy, and carotid intima media thickness treatment methods and effects on oxidative stress markers

Objective: Oxidative stress has an important role in course and progression of disease in chronic kidney failure patients. It?s known that oxidative stres and marker levels belonging to this are changing with the increasing volume, reductions in oxidative stress appeared by treatment affect the progression of disease favorably. Fluid removal by ultrafiltration and diuretic treatment in hypervolemic patients for fluid removal are commonly used methods. In this study we aimed to compare the effects of ultrafiltration and diuretic treatment on oxidative stres markers, carotis intima media thickness and left ventricular mass index in CHF, RF, DM, cardiorenal syndrome patients that come with signs of volume overload. Material-Method: In this study 77 patients are included who refer with significant signs of volume overload to Duzce University Medical Faculty Hospital Internal Medicine, Nephrology, Cardiology and Emergency Medicine polyclinics between the dates October 2011- December 2012, have at least one of CHF, RF, DM diseases and consist of 41 women, 36 men that have appropriate criteria. Patients in rutine hemodialysis programme, who had diuretic therapy before and who did not sign informed consent excluded from the study. This study continued nearly 2 weeks until the patients become euvolemic. Parameters like blood and urine samples, thorax graphies, echocardiography, carotis intima-media thickness are evaluated before and after the therapy for biochemical analysis. Oxidative stress markers like catalase, MDA, glutathione peroxidase and superoksid dismutase are measured before and after the therapy. Left ventricule end diastolic and sistolic diameter, interventricular septum thickness are recorded by echocardiographic study. Ejection fraction is calculated by modified Simpson method. PAB is measured. Left ventricule mass index is calculated by Devereux Formula. Carotis intima-media thickness evaluation from right and left carotid arteries is viewed by ultrasound machine by the same doctor. Results: Body weight, body mass index and age of groups were similar before the therapy. In both therapy groups, PAB, EF, LVMI, BMI values showed significant decrease before and after the therapy, but this was not meaningful when 2 groups were compared. After the therapy there were significant increases in BUN levels at the group that had diuretic therapy. There were no significant change in urine dansities after the therapy in both groups. At the beginning there was no difference between 2 groups of GSH-Px, SOD, catalase and MDA levels. After the therapy there were decreases in both GSH-Px and SOD levels and increases in catalase and MDA levels compared with pretreatment in UF group. In diuretic group, there were decreases in GSH-Px and catalase levels and insignificant increases in SOD and MDA levels after the therapy. Conclusion: In this study ultrafiltration and diuretic treatment modalities for fluid removal in hypervolemic patients who have at least one of cardiorenal syndrome, CHF, CRF, DM diseases are compared. Along with effects of UF and diuretic treatment to improvement of hypervolemia are similar, effects on parameters like oxidative stres markers, KIMK, PAB, LVMI, EF, lipid parameters, total protein, alterations in electrolite (Na+, K+, Ca+2, Cl-) values, urine density, proteinuria in spot urine are also similar. Key Words: Hypervolemia, Ultrafiltration, Markers of Oxidative Stress