5.1. Oral supplementation

• decreases ADMA and increases NO synthase activity and NO synthesis; and

All these listed above have been found in small in in vitro or in vivo studies [8–17].

There are two large controlled trials on patients with renal failure, SPACE and HOPE studies, that found either a significant reduction in cardiovascular risk and myocardial infarction in end-stage renal disease patients treated with oral alpha-tocopherol as compared to placebo, or similar effect of vitamin E treatment and ramipril on cardiovascular outcome in patients with

It was demonstrated that vitamin E reduces lipid peroxidation and it decreases electronegatively charged LDL-subfraction, but if it also reduces the triglycerides or total cholesterol, it is uncertain. Some studies found that short-term high doses of vitamin E had no benefits in a majority of renal patients in regards to their circulating levels of high-density lipoprotein cholesterol [16, 17].

Vitamin E-deficient muscle in animals has been shown to provide increased susceptibility to

Radical-mediated oxidative damage of skeletal muscle membranes has been implicated in the fatigue process. Moreover, in hemodialysis patients, ROS-mediated damages occur during hemodialysis-induced muscle hypoperfusion and ischemia, as well as because of activation of macrophages and leukocytes passing dialysis membranes. Vitamin E is a major chain-breaking antioxidant that has been shown to reduce contraction-mediated oxidative damage. Vitamin E deficiency would adversely affect muscle contractile function, resulting in a more rapid devel-

Anemia is an important cause of morbidity and mortality in chronic hemodialysis patients. Treatment with erythropoiesis-stimulating agents is influenced by many factors that can induce

An imbalance between oxidant and antioxidant system in hemodialysis patients is well known. Any studies found low levels of superoxide dismutase and decreased activity of

• reduces cytokine production.

36 Vitamin E in Health and Disease

mild and moderate renal failure [18, 19].

4.3. Hypolipidemic effect

4.4. Ameliorates muscle cramps

opment of muscular fatigue during exercise [4, 20].

4.5. Erythropoietin doses reduction

erythropoietin resistance, such as:

• folate and vitamin B12 deficiency

• bleeding

• iron deficiency

• inflammation • oxidative stress

peroxidative damage.

The European Best Practice Guidelines on Renal Nutrition recommend a daily supplement of 400–800 IU for the secondary prevention of cardiovascular events and recurrent muscle cramps [4, 20, 22].
