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Oxidative Medicine and Cellular Longevity
Volume 2017, Article ID 3081856, 22 pages
Review Article

Oxidative Stress in Hemodialysis Patients: A Review of the Literature

1Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
2Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto von Guericke University Magdeburg, Magdeburg, Germany
3Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece

Correspondence should be addressed to Vassilios Liakopoulos; rg.teneto@lupokail

Received 14 May 2017; Accepted 14 August 2017; Published 12 September 2017

Academic Editor: Janusz Gebicki

Copyright © 2017 Vassilios Liakopoulos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hemodialysis (HD) patients are at high risk for all-cause mortality and cardiovascular events. In addition to traditional risk factors, excessive oxidative stress (OS) and chronic inflammation emerge as novel and major contributors to accelerated atherosclerosis and elevated mortality. OS is defined as the imbalance between antioxidant defense mechanisms and oxidant products, the latter overwhelming the former. OS appears in early stages of chronic kidney disease (CKD), advances along with worsening of renal failure, and is further exacerbated by the HD process per se. HD patients manifest excessive OS status due to retention of a plethora of toxins, subsidized under uremia, nutrition lacking antioxidants and turn-over of antioxidants, loss of antioxidants during renal replacement therapy, and leukocyte activation that leads to accumulation of oxidative products. Duration of dialysis therapy, iron infusion, anemia, presence of central venous catheter, and bioincompatible dialyzers are several factors triggering the development of OS. Antioxidant supplementation may take an overall protective role, even at early stages of CKD, to halt the deterioration of kidney function and antagonize systemic inflammation. Unfortunately, clinical studies have not yielded unequivocal positive outcomes when antioxidants have been administered to hemodialysis patients, likely due to their heterogeneous clinical conditions and underlying risk profile.