| Objective:This system review aimed to quantify different biomarkers to investigate whether dialysis exacerbates lipid peroxidation damage in patients with end-stage renal disease(ESRD),whether hemodialysis(HD)causes more severe lipid peroxidation damage than peritoneal dialysis(PD),and whether antioxidant therapy can improve lipid peroxidation damage in dialysis patients.Methods:Systematically searched PubMed,Embase and Cochrane library databases,comprehensively collected studies meeting inclusion and exclusion criteria,and conducted meta-analysis of eligible study results using RevMan 5.3 and Statal2.0 software.The mean content of lipid peroxidation biomarkers in ESRD patients was evaluated using the calculated standardized mean difference(SMD)and 95%confidence interval(95%CI).Results:A total of 12 studies comparing lipid peroxide level between HD and ESRD patients without dialysis were included,and a total of 6 studies comparing lipid peroxide level between PD and ESRD patients without dialysis were included.The results of meta-analysis showed that:Compared with non-dialysis ESRD patients,HD patients had higher levels of lipid peroxidation(SMD=0.78,95%CI 0.21～1.35,P=0.008).Among them,malondialdehyde(MDA)levels(SMD=0.79,95%CI 0.12～1.45,P=0.02)and lipid peroxide levels(SMD=0.87,95%CI 0.50～1.25,P<0.0001)were higher than those of ESRD patients without dialysis;Compared with non-dialysis ESRD patients,lipid peroxidation levels in PD patients were not significantly different(SMD=0.41,95%CI-0.63～1.46,P=0.44).A total of 26 studies were included to compare lipid peroxidation levels between HD and PD patients,including a total of 3 996 patients.Meta-analysis results showed that compared with PD patients,total lipid peroxidation levels in HD patients were higher(SMD=0.71,95%CI 0.41～1.00,P<0.0001),MDA level(SMD=0.66,95%CI 0.29～1.45,P=0.0004),ox-LDL level(SMD=0.52,95%CI 0.25～0.79,P=0.0002),8-isoprostaglandin-F2(8-Iso-PGF2)levels(SMD=1.23,95%CI-0.85～1.61,P<0.0001)and 4-hydroxynonenoic acid(4-HNE)levels(SMD=2.70,95%CI 1.95～3.45,P<0.0001),but there was no significant difference in lipid peroxide levels(SMD=0.36,95%CI-0.38～1.10,P=0.34).A total of 29 clinical randomized controlled trials(RCTS)involving 810 patients were included in antioxidant treatment of lipid peroxidation injury in dialysis patients,including 8 interventions including vitamin C supplement,vitamin E supplement,vitamin E-coated dialyzer,supplementation of ω-fatty acids,curcumin supplement,fruit juice supplement,exercise therapy and multiple antioxidant therapy.Meta-analysis showed that MDA levels in dialysis patients were significantly decreased after vitamin C supplementation(SMD=-0.53,95%CI-0.82～-0.24,P=0.0004).After vitamin E supplementation,MDA levels(SMD=-0.21,95%CI-0.42～0.01,P=0.04)and Ox-LDL levels(SMD=-3.90,95%CI-5.20～2.59,P<0.0001)was significantly decreased,while the 4-HNE level was not significantly improved(SMD=-0.09,95%CI-0.62～0.43,P=0.73).After treatment with vitamin E coated dialyzer,Ox-LDL levels in dialysis patients were improved compared with those before treatment(SMD=-0.70,95%CI-1.32～0.09,P=0.02),≥3 months of treatment could significantly improve MDA levels(SMD=-0.70,95%CI-1.20～0.20,P=0.006),but<3 months had no effect(SMD=-0.19,95%CI-1.95～1.57,P=0.83).After supplementation of ω-fatty acids,MDA level of dialysis patients was not improved compared with that before treatment(SMD=0.21,95%CI-0.63～1.05,P=0.62).After curcumin supplementation,MDA level of dialysis patients was not improved compared with that before treatment(SMD=0.03,95%CI-0.70～0.75,P=0.94).After juice supplementation,MDA levels were decreased(SMD=-3.62,95%CI-6.77～0.47,P=0.02)and Ox-LDL levels(SMD=-6.60,95%CI-8.60～4.59,P<0.0001)significantly reduced;MDA levels in dialysis patients decreased after exercise therapy(SMD=-1.18,95%CI-1.48～0.48,P<0.0001),Ox-LDL level was not significantly decreased(SMD =-0.26,95%CI-1.24～0.73,P=0.61);MDA levels(SMD=-0.62,95%CI-1.05～0.19,P=0.005)and Ox-LDL levels were significantly decreased(SMD=-4.10,95%CI-5.45～2.75,P<0.0001).Conclusions:1.Compared with non-dialysis ESRD patients,the level of lipid peroxidation in HD patients is higher,although the level of lipid peroxidation in PD patients was higher than that in ESRD patients without dialysis,there was no statistical difference.2.Compared with PD patients,HD patients with higher level of lipid peroxidation.3.Added vitamin C,added vitamin E,≥ 3 months of vitamin E coated dialyzer treatment,fruit juice,sports therapy,multiple antioxidant therapy can effectively improve the state of lipid peroxidation of dialysis patients,and<3 months of vitamin E coated dialyzer treatment,added omega fatty acids and supplementary treatment of curcumin state of lipid peroxidation in patients with dialysis treatment has no obvious improvement. |
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