**Author details**

*Antioxidants*

**5. Conclusions**

**Conflict of interests**

**Abbreviations**

There is no conflict of interest.

OS oxidative stress

CKD chronic kidney diseases PD peritoneal dialysis DM diabetes mellitus LPO lipoperoxides 8-IP 8-isoprostanes NO nitric oxide

SOD superoxide dismutase

anion responsible for the increase in lipid peroxidation [21]; however, in the patients included in the study, SOD was found to be significantly increased and TAC decreased in patients undergoing PD with DM and No-DM, which could suggest that peritoneal replacements could purge the systemic buffering levels of the TAC. In a recently reported study, the authors underwent to hemodialysis session in patients with ESRD; they found a significant reduction in TAC according to our findings [33]. The depletion of TAC found in patients undergoing PD is contrary to that reported by other authors in relation to increased levels of these systemic buffers in patients undergoing hemodialysis. [34]. The concentrations of bilirubin, uric acid, and plasma albumin are the main defense in the extracellular fluids generated during the normal metabolism or are ingested by the consumption of dietary products rich in antioxidants [35]. These extracellular antioxidants prevent the reaction of free radicals by sequestering transition metal ions by plasma chelation [36]; the TAC is able to determine these extracellular antioxidants. In the present study, TAC

was found to be significantly consumed in all patients included.

better hemoglobin response during the treatment of anemia [37].

counteract OS with the potential to preserve peritoneal function.

The addition of exogenous antioxidants to the management of patients who are in PD is an incomplete and little studied subject; however, this topic is interesting that is well worth considering in these patients. In a report of the literature, the authors studied the N-acetylcysteine (NAC) which is considered as a potential antioxidant with anti-inflammatory effects for dialysis patients. Vitamin C could play an important role in helping PD patients to use iron for erythropoiesis and achieve

When comparing patients in PD according to the presence or absence of DM, we found imbalance of markers of oxidative stress characterized by increased LPO products, serum decrease of 8-PI, dysregulation of the antioxidant defense system with significant decrease in TAC, and increase in SOD possibly in an attempt to compensate for the state of oxidative stress. In this population, increased levels of triglycerides and VLDL were observed, which favors the appearance of accelerated atherosclerosis with an increase in arterial stiffness, as well as a decrease in NO levels, which favors secondary endothelial dysfunction. These factors contribute to the increase of CVD in PD patients. Supplementation with external antioxidants could be an emerging strategy to

**346**

Leonardo Pazarín-Villaseñor1,2, Julio Alejandro Gutiérrez-Prieto1 , Javier Soto-Vargas1 , Renato Parra-Michel1 , Andrés García-Sanchez<sup>3</sup> and Alejandra Guillermina Miranda-Diaz<sup>3</sup> \*

1 Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Especialidad en Nefrologia, Hospital General Regional Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico

2 Servicio de Nefrología, División de Medicina Interna, Hospital Civil de Guadalajara "Dr. Juan I Menchaca", Guadalajara, Jalisco, Mexico

3 Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico

\*Address all correspondence to: kindalex1@outlook.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
