Inflammation in Chronic Kidney Disease Page Oxidative stress is often cited as an important mediator of tissue damage. People who have chronic kidney disease (CKD) are prone to atherosclerosis and cardiovascular events. Oxidative stress is highly prevalent in patients with CKD and even more common in patients with end-stage renal disease (ESRD).
Factors such as age, diabetes, hypertension, inflammation, incompatibility of dialysis membranes, and dialysate solutions, together with lower antioxidant defense (reduced activity of the glutathione system, low levels of vitamins E and C), can contribute to oxidative stress. In patients with CKD, oxidative stress has been linked to several surrogate markers of atherosclerosis such as endothelial dysfunction and intima-media thickness. Unfortunately, there are few large epidemiological studies testing hard endpoints.
However, oxidative stress might also influence response to erythropoiesis-stimulating agents (ESAs), possibly by reducing the natural life span of red blood cells and iron metabolism. ESA dose could be a practical marker to use in a clinical setting, as well as in clinical studies.