Oxidative Stress in Hemodialysis Patients: Pathophysiological Mechanisms, Clinical Consequences and basic Principles of Treatment

Microinflammation is a non-traditional risk factor for the development of cardiovascular diseases in patients on hemodialysis. It occurs in 30–50% of these patients, and its main causes are: uremic toxins, oxidative stress, metabolic acidosis, vitamin D deficiency, overhydration, altered intestinal microbiome, impaired intestinal epithelial barrier integrity, increased translocation of endotoxin from the intestinal lumen into the systemic circulation, occult infection of the vascular approach for hemodialysis, periodontal disease, bioincompatibility of the hemodialysis membrane and the presence of endotoxin in the hemodialysis solution. The main clinical consequences of microinflammation are: accelerated atherosclerosis, malnutrition, anemia, resistance to the action of erythropoietin, hemoglobin variability and dialysis-related amyloidosis. Postdilution online hemodiafiltration, extended and adsorptive hemodialysis prevent the development of microinflammation. Optimal control of microinflammation prevents the development of cardiovascular diseases, improves the quality of life and the outcome of patients who are treated with regular hemodialysis.