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Abstract: TH-PO261

Effect of Antioxidants on Oxidative Stress, Endothelial Dysfunction, Inflammatory Markers, and Carotid Intima Media Thickness in Maintenance Hemodialysis and Renal Transplant Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Goswami, Himanish, Apollo Hospitals Guwahati, Guwahati, Assam, India
  • Bora, Mitul, Apollo Hospitals Guwahati, Guwahati, Assam, India

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in dialysis patients. Various non-traditional factors have been proposed for the increased incidence of CVD. N-acetylcysteine (NAC) serves as an antioxidant, acts on atherosclerosis and also improves the endothelial functions.This study was designed to assess the effects of three months of NAC therapy on oxidative stress, endothelial dysfunction, inflammatory markers and carotid intima media thickness in maintenance hemodialysis and renal transplant patients.


Doppler was done to assess endothelial function by flow mediated dilatation (FMD) of the brachial artery and carotid arterial intima media thickness (CIMT). Brachial artery was imaged during reactive hyperemia (endothelium-dependent, flow-mediated dilatation, FMD) and during nitroglycerine-mediated dilatation (NMD, endothelium-independent). Oxidants (Melondialdehyde, MDA) and antioxidants (Total Antioxidant Status) were measured. NAC 1200 mg was given in two divided doses for three months.Parameters were repeated after three months of NAC therapy.


220 hemodialysis,135 renal transplant patients were enrolled. Hemodialysis patients had higher serum homocysteine level which was significantly reduced after three months of NAC (25.7±3.86 vs 13.9±3.01 µmol/L after NAC,p<0.001). At baseline they had a high hsCRP (05.6±1.01 mg/dl) which reduced significantly (02.1±0.43 mg/dl,p<0.001) after NAC. CIMT was significantly reduced after three months of NAC (0.49±0.12mm). FMD of brachial artery endothelium was impaired at baseline (0.34±0.07mm,0.69±2.11%) ,significant improvement after 3 months of NAC (0.41±0.11mm,10.12±2.86%,p<0.001). Elevated baseline oxidative stress markers (MDA) compared to levels after NAC (16.21±10.34 vs 09.31±4.34 nmol/ml,p<0.001).Antioxidant status was significantly low at baseline (1.03±0.21 mmol/l) compared to antioxidant status after NAC (1.41±0.24 mmol/l,p=0.01). Similar findings were seen in the post renal transplant patients.


CKD patients have endothelial dysfunction and oxidative stress which begins early, progresses during dialysis and persists after renal transplantation. With three months of therapy, NAC significantly reduces the oxidative stress, inflammatory markers and improves the endothelial function.