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Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 623-627
The study of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels

1 Department of Clinical Biochemistry, School of Medicine and Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Kermanshah University of Medical Sciences, Kermanshah, Iran

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Date of Web Publication21-Aug-2017


Background: Chronic renal failure (CRF) is one of the most prevalent diseases of human societies, especially in Iran. Despite all advances that have been made so far, hemodialysis with all its complications is being applied as the novel treatment strategy for such individuals. Objective: The aim of this study is to investigate the effect of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels. Materials and Methods: This study is an analytical research which used a convenience sampling method. Malondialdehyde (MDA) as the indicator of lipid peroxidation and L-creatinine was measured in 27 patients (17 males and 10 females). Malondialdehyde was calculated using the standard thiobarbituric acid (TBA) method and L-creatinine through the t-test enzymatic method (Roche kit) (SpectronicGenesys 340 nm). Results: The mean and standard deviation of serum L-creatinine before and after dialysis was 7.67 ± 3.6 mg/L and 2.07 ± 1.6 mg/L, respectively (P < 0.001). The MDA mean of serum before and afterdialysis was 4.17 ± 1.24 mol/L and 4.98 ± 1.2 mol/L, respectively (P < 0.001). Conclusion: Analyses show that serum L-creatinine reduces considerably after dialysis. In addition, the results suggest that stress oxidative reduces following hemodialysis in these patients, which is observed in the form of the increased lipid peroxidation.

Keywords: Chronic renal failure, hemodialysis, serum L-creatinine, lipid peroxidation

How to cite this article:
Haghnazari L, Nomani H, Vaisi-Raygani A, Esfahani M, Foroughinia S. The study of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels. Ann Trop Med Public Health 2017;10:623-7

How to cite this URL:
Haghnazari L, Nomani H, Vaisi-Raygani A, Esfahani M, Foroughinia S. The study of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels. Ann Trop Med Public Health [serial online] 2017 [cited 2021 Mar 8];10:623-7. Available from:

   Introduction Top

Chronic renal failure (CRF) is one of the most prevalent diseases of human societies, especially in Iran. Despite all advances that have been made so far, hemodialysis with all its complications is being applied as the novel treatment strategy for such individuals. Thousands of people with complete kidney damage have been saved from certain death through this treatment method.[1] Kidneys are the key to developing and maintaining the normal level of creatinine as well as removing the excess acyl groups resulted from the fatty acids oxidation. Accordingly, a balance is made between the acyl-coenzyme A/acyl ratio in mitochondria which is necessary for normal cell metabolism. The main role of creatinine is in fatty acid metabolism; therefore, change in concentrations affects the fatty acid metabolism and its disorders.[2],[3]

Stress oxidative is a reaction in which the balance rate between oxidant and anti-oxidant factors is impaired in biological systems with macromolecules such as lipids, proteins, nucleic acids, and polysaccharides prone to damage.[4] Considering lipids as the major components of cell membrane and blood circulation (in form of lipoprotein), it seems they are more susceptible to damage. Among the specific examples of the damages is lipid peroxidation that plays a role in many degenerative reactions.[5] In hemodialysis patients, due to the antioxidants compounds release throughout the process, the potential of developing the above reaction increases and damage to various types of biomolecules is exacerbated.[6] A study conducted by Samouilidouin and Grapsa [7] in 2003 showed that in hemodialysis patients, the concentration of plasma antioxidants in pre- and post-dialysis samples underwent a significant change. The obtained results of a study by Nandi et al.[8] demonstrated that MDA values in hemodialysis people before and after the dialysis procedure had a significant difference and that it decreased after hemodialysis. However, Lin et al.[9] suggested that MDA value does not change before and after dialysis because it is fixed.

The aim of this research is to study serum L-creatinine changes (free-creatinine) and the production of serum lipid peroxidation before and after hemodialysis and then make a comparison between these two factors.

   Materials and Methods Top

This is an analytical study based on a before–after model where sample selection was done through the available or convenience sampling method. Patients in hemodialysis ward of The Fourth Altar Martyre Hospital in Kermanshah were studied. Samples were selected from the people undergoing hemodialysis over a period of 6 months to 1 year. Magi hemodialysis machines included digital and filtered R5 was used.

The SD value before and after serum L-creatinine changes was evaluated after a minimum of 27 patients were selected through consultation and based on a similar study.[1] Of 27 participants, 17 were males and 10 females belonging to different age groups. The related features of age, sex, hemodialysis history, times of hospital admission per week, and family history of hemodialysis were recorded in the research questionnaire.

Before starting dialysis and at the end of it, patient's weight was measured and included in the questionnaire. Before starting the hemodialysis, a 10 cc blood sample was taken from all patients of which 5 cc was poured into a plastic tube without anticoagulant and the other half in a tube containing 2 drops of 0.5 EDTA. Samples were transferred to the laboratory where the serum was separated from the plasma and then kept in a freezer at –20 °C until the time of testing. At the end of dialysis, the speed of the pump was reduced to 50 mL/min and after 10 s, 10 cc blood was taken once again from the arterial line and was subjected to the similar procedure as mentioned above. The applied devices included Geneses 2 spectrophotometer, Hermlehettich universal centrifuge, Labtron vertex, Fater electronic Bain-marie, and Hettich universal scale.

The relative frequency distribution table was used for qualitative (categorical) variables, the mean, and standard deviation as well as for calculating the percentage of changes. The following equation was used: pre- and postdifferences divided by the previous value multiplied by 100. Acceptance or rejection of the hypotheses was conducted based on Levens, paired t-test, and independent t-test. The Mann–Withney test was used in some subgroups such as family history due to the small sample size. The nonparametric kolmogorov–Smirnov test was used to confirm the data of normality. The Pearson correlation coefficient was used to calculate correlation.

   Results Top

In total 27 patients suffering from chronic renal failure and undergoing hemodialysis were studied. They included 17 males (63%) and 10 females (37%). Patients' age ranged from 24 to 80 years of which 51.9% were over the age of 50 years. Patients' weight before and after dialysis was between 40 and 86.5 kg and 38 and 82.5 kg, respectively, and percentage of weight loss was between 0.5 and 4 kg. Of total patients, 92.6% underwent dialysis three times a week, 3.7% twice a week, and 3.7% once a week. Only 11.1% family history in dialysis was reported.

The mean of serum L-creatinine before dialysis in males and females was 8.69 ± 3.66 mg/L and 5.93 ± 2.88 mg/L, respectivey. No difference was observed between both sexes (P > 0.053, although this value was higher in males after dialysis and difference was significant in both sexes (P < 0.01). There was a significant MDA difference in both sexes before and after dialysis (P < 0.05) [Table 1]. Using the Pearson correlation coefficient, it was demonstrated that there is a relationship between the average of L-creatinine difference and MDA before and after hemodialysis (r = 0.75 and r = 0.82).
Table 1: The mean and standard deviation Kt/V, L-Carnitine, and MDA in both sexes

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P–value shows that in the measured parameters, no significant difference was observed between two dialysis adequacy groups (P > 0.05) [Table 2].
Table 2: The mean and standard deviation of L-carnitine and MDA before and after hemodialysis based on dialysis adequacy

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P value indicates that in these parameters, there is no significant difference between two age groups, using independent t-test and Levens test (P > 0.50) [Table 3].
Table 3: The mean and standard deviation kt/V, L-carnitine, and MDA in two age groups of younger and older than 50

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L-creatinine before and after hemodialysis was higher in group with family history than that with no history; however, the difference was not significant (P = 0.16). Furthermore, in other parameters, no difference was observed between the two groups with and without family history [Table 4].
Table 4: The mean and standard deviation of the mainmeasured parameters based on family history

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The confidence interval chart showed the percentage of changes in the mean values of L-creatinine and serum MDA according to sex with confidence of 95%; the percentage of the changes in the average values in males was found to be 58–78% and in females 75–90%. With 95% confidence, the change of the mean values of serum MDA in males and females was 20–28% and 8–25%, respectively.

   Discussion Top

The present study was conducted to investigate the effect of hemodialysis on the change rate of serum L-creatinine and lipid peroxidation levels in target patients in Kermanshah. The aim of performing hemodialysis is not only protecting patients' individual life despite suffering kidney failure but also restoring optimum quality of life. The existing evidence suggests that in spite of impressive advances in this therapy, a great percentage of patients under treatment suffer from the resulted complications.[10]

The results of this research demonstrated the significant difference of serum L-creatinine before and after hemodialysis. These results are consistent with the studies conducted by Evans (2003) in Australia,[2] Suzuki et al. (1982) in Japan,[11] and Alhomida (1996) in Saudi Arabia.[1] The obtained results L-creatinine value before and after hemodialysis are closer to the reported values in Saudi Arabia.

The mean and standard deviation of MDA before and after hemodialysis were 4.17 and 4.98, respectively, which showed a significant difference. It was consistent with the studies of Ozden et al. (2002)[12] in Turkey and Nandi et al. (1997)[8] in India, whereas it was inconsistent with the study of Gonenc et al. (2002)[13] since the pre- and posthemodialysis values were 6.69 and 6.14, respectively.

Based on this study, it can be argued that hemodialysis has an effect on serum L-creatinine and lipid peroxidation changes which led to the reduction of serum L-creatinine and increase in lipid peroxidation. Different studies on L-creatinine and serum MDA changes in pre- and postdialysis samples gave a number of different results due to various reasons. Duration of hemodialysis,[14] nutritional status, the use or nonuse of antioxidant compounds,[15] and hemodialysis machines and their conditions [16],[17] are among variables which cause differences in the above values.

There are possible mechanisms which leads to decrease in creatinine. Low molecule weight, water solubility, and slightbinding to plasma protein result in the compound been released from blood; on the other hand, dialysis clearance of acyl-creatinine is lower compared with that of free form (due to the molecular weight gradient and higher lipophilicity). These factors make the AC/FC ratio exceed the normal range (less than 0.4) thereby increasing.

The preparation level for oxidative stress is basically associated with the produced MDA level in plasma.[7],[18] Conducted studies showed that there is a possible increase in MDA due to many different reasons among which are incomplete correction of uremic toxicity, chronic hemolysis of red blood cells, changes in antioxidant defenses, increased production of free radicals, increased pre-oxidants such as heightened prevalence of diabetes, and so on.

Oxidative stress causes other complications including immune dysfunction and increased risk of infectious diseases,[19] malignancy,[20] diabetes,[21] peripheral and central nervous system disorders,[22] and exacerbation of senescence [23] in hemodialysis patients. It seems that controlling oxidative stress conditions leads to profound effects on reducing inflammation, anemia, and atherosclerosis which could be associated with reducing the mentioned complications.

   Conclusion Top

In the end, besides recommending the use of supplement for possible removal of this decrease, it is suggested that in the later studies using L-creatinine supplement; measuring plasma lipid profile and oxidative stress indicator; and plasma total antioxidant capacity must be assessed simultaneously. Furthermore, the relationship between oxidative stress and inflammation; oxidative stress and anemia; and possible association among stress, inflammation, and anemia; the changes in L-creatinine, oxidative stress, and cardiovascular risk factors in hemodialysis patients; and also possible connection between oxidative stress and different types of dialysis membranes should be studied.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Alhomida AS. Effect of chronic renal hemodialysis on serum total, free and acyl carnitine concentrations in adult chronic pyelonephritis patients. Arch Med Res 1996;28:101–7.  Back to cited text no. 1
Evans A. Dialysis-related carnitine disorder and levo- Carnitine pharmacology. Am j Kidney Dis 2003;41 (4 supple 4):13–26.  Back to cited text no. 2
Hoppel C. The role of carnitine in normal and altered fatty acid metabolism. Am J Kidney Dis 2003;30:4–12.  Back to cited text no. 3
Ronco C, La-Grec A. Pathopysiology of oxidative stress and its implication in uremia and dialysis. Contrib Nephrol Basel 1999;127:1–37.  Back to cited text no. 4
Safari MR. Free radicals in biological system. Hamadan: Hamadan University of Medical Science Publication; 2002. pp. 154–70.  Back to cited text no. 5
Halliwell B, Gutteridge JM. Role of free radicals and catalytic metal ions in human disease: An overview. Meth Enzymol 1990;186:1–85.  Back to cited text no. 6
Samouilidou E, Grapsa E. Effect of dialysis on plasma total antioxidant capacity and lipid peroxidation products in patients with end-stage renal failure. Blood Purif 2003;21:209–12.  Back to cited text no. 7
Nandi N, Suri SA, Ggarwal HK. Lipid peroxidation before and after hemodialysis in chronic renal failure. Indian J Nephrol 1997;7:58–62.  Back to cited text no. 8
Lin TH, Chen JG, Liaw JM, Juang JG. Trace elements and lipid peroxidation in uremic patients on hemodialysis. Biol Trace Elem Res 1996;51:277–83.  Back to cited text no. 9
Miller B, Ahmad S. A review of the impact of L-carnitine therapy on patient functionality in maintenance hemodialysis. Am J Kidney Dis 2003;41:44–8.  Back to cited text no. 10
Suzuki Y, Narita M, Yamazaki N. Effects of L-carnitine on arrhythmias during hemodialysis. Japanese Heart Journal 1982;23(3):349-59.  Back to cited text no. 11
Ozden M, Maral H, Akaydin D. Erythrocyte glutathione peroxidase levels in hemodialysis and CAPD Patients. Clin Bio Chem 2002;35:269–73.  Back to cited text no. 12
Gonenc A, Atak Y, Orman M, Simsek B. Lipid peroxidation and antioxidant system in hemodialysis patients. Dial Transplant 2002;31:88–98.  Back to cited text no. 13
Nguyen-Khoa T, Massy ZA, De Bandt JP, Kebede M, Salama L, Lambrey G, et al. Oxidative stress and haemodialysis: Role of inflammation and duration of dialysis treatment. Nephrol Dial Transplant 2001;16:335–40.  Back to cited text no. 14
Laciak M. Antioxidant in the treatment of patients with renal failure. Roxzniki Akademil Medyczney WBialymstoka 2004;49:157–61.  Back to cited text no. 15
Kaysen GA. The microinflammatory state in uremia: Causes and potential consequences. J Am Soc Nephrol 2001;12:1549–57.  Back to cited text no. 16
Sasaki M, Hosoya N, Sarahashi M. Development of vitamin E modifed memberance: In RonocoC, La Greca: Vitamin E bonded membrane. A failure step in dialysis optimization. Contrib Nephrol Basel Karger 1999;127:32–43.  Back to cited text no. 17
Goksek S, Kubra P, Handan SL. Carnitine ameliorates oxidative damage due to chronic renal failure in rats. J Cardiovasc Pharmacol 2004;43:698–705.  Back to cited text no. 18
Galli F, Rovidati S, Benedetti S. Lipid peroxidation, leukocyte function and apoptosis in hemodialysis patients treated with vitamin E modified filters. Contrib Nephrol Basel Karger 1999;127:156–71.  Back to cited text no. 19
Tarng DC, Huang TP, Liu TY. Effect of vitamin E-bonded membrane on the 8-hydroxy 2,-deoxyguanosine level in leukocyte DNA of hemodialysis patients. Kidney Lnt 2000;58:790–9.  Back to cited text no. 20
Dypbukt JM, Ankarcrona M, Burkitt M. Different prooxidant levels stimulate growth, trigger apoptosis, or produce necrosis of insulin secreting RIN m5 F cells. J Biol Chem 1994;269:30553–60.  Back to cited text no. 21
Deng G, Vaziri ND, Jabbari B. Increased tyrosine nitration of the brain in chronic renal insufficiency: Reversal by antioxidant therapy and angiotensin- converting enzyme inhibition. J Am Soc Nephrol 2001;12:1892–9.  Back to cited text no. 22
Grane T, Sommerburg O, Siems WG. Oxidative stress in anemia. Clin Nephrol 2000;53(supple 1):18–22.  Back to cited text no. 23

Correspondence Address:
Hamid Nomani
Department of Clinical Biochemistry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_113_17

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  [Table 1], [Table 2], [Table 3], [Table 4]


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