6. Side effects of vitamin E supplementation

Usually, no side effects have been seen using doses of 400–800 UI/d, even though, in prolonged administration, some of the effects listed below could be possible [20, 22]:

• accumulation of metabolites;

• paradoxical pro-oxidant effects due to the reduction of antioxidant defense system components;

[9] Maccarrone M, Meloni C, Manca-di-Villahermosa S, et al. Vitamin E suppresses 5 lipoxygenase-mediated oxidative stress in peripheral blood mononuclear cells of hemodialysis patients regardless of administration route. American Journal of Kidney Diseases.

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[10] Cristol JP, Bosc JY, Badiou S, et al. Erythropoietin and oxidative stress in hemodialysis: Beneficial effects of vitamin E supplementation. Nephrology, Dialysis, Transplantation.

[11] Galli F, Rovidati S, Chiarantini L, et al. Bioreactivity and biocompatibility of a vitamin Emodified multi-layer hemodialysis filter. Kidney International. 1998;54(2):580-589

[12] Yamadera S, Nakamura Y, Inagaki M, et al. Vitamin E-coated dialyzer inhibits oxidative

[13] Zoccali C, Bode-Böger S, Mallamaci F, et al. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: A prospective study.

[14] Saran R, Novak JE, Desai A, et al. Impact of vitamin E on plasma asymmetric dimethylarginine (ADMA) in chronic kidney disease (CKD): A pilot study. Nephrology, Dialysis,

[15] Pertosa G, Grandaliano G, Soccio M, et al. Vitamin E-modified filters modulate Jun Nterminal kinase activation in peripheral blood mononuclear cells. Kidney International.

[16] Mafra D, Santos FR, Lobo JC, et al. Alpha-tocopherol supplementation decreases [LDL(-)] in hemodialysis patients. Nephrology, Dialysis, Transplantation. 2009;24(5):1587-1592

[17] Locatelli F, Canaud B, Eckardt K-U, et al. Oxidative stress in end-stage renal disease: An emerging threat to patient outcome. Nephrology, Dialysis, Transplantation. 2003;18(7):

[18] Boaz M, Smetana S, Weinstein T, et al. Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): Randomized placebo-controlled trial.

[19] Mann JF, Lonn EM, Yi Q, et al. HOPE Investigators. Effects of vitamin E on cardiovascular outcomes in people with mild-to-moderate renal insufficiency: Results of the HOPE study.

[20] Rocco MV, Alp Ikizler T. Nutrition. In: Daugirdas JT, Blake PG, Ing TS, editors. Handbook of Dialysis. 4th ed. Phladelphia, USA: Lipincott Williams and Wilkins. 2007. pp. 462-478

[21] Rusu A, Rusu F, Zalutchi D, et al. The influence of vitamin E supplementation on erythropoietin responsiveness in chronic hemodialysis patients with low levels of erythrocyte

[22] Fouque M, Vennegoor P, Wee T, et al. EBPG guideline on nutrition. Nephrology, Dialysis,

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1272-1280

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• bleeding, diarrhea, blurry vision, and headache are rare.

In conclusion, vitamin E proved its antioxidant effects in hemodialysis patients, decreasing ROS synthesis and cellular damages, reducing lipid peroxidation, platelet aggregation and limiting atherosclerosis, improving antioxidant defense and ameliorating anemia treatment in hemodialysis patients. It is safe to use doses of vitamin E that should not exceed 1000 Ui/d in selected hemodialysis patients, especially to reduce cardiovascular risk, improve muscle cramps, and reduce required erythropoietin doses.
