In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV)
origin. The underlying mechanisms are complex, given that sudden heart failure is more common than
acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased
even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage
renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues
when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating
antioxidant defence systems. During the last decade, a close association of oxidative stress with
accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid
peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis.
In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay,
CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize
existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins,
omega-3 fatty acids and N-acetylcysteine.
Hyperhomocysteinemia in end-stage renal disease: Prevalence, etiology, and potential relationship to arteriosclerotic outcomes
