***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Cardiovascular disease represents the most common cause for the excess of morbidity and mortality found in end-stage renal disease ( ESRD ) and has prompted the exploration of multiple approaches to improve outcomes in these patients . Cardiovascular risk factors such as increased oxidative stress ( OxSt ) and inflammation are found in ESRD patients . A vitamin E-coated dialyzer using polysulfone membranes has been suggested to have positive effects on these factors . This 1-year study evaluated in 25 ESRD patients under chronic dialysis , the effects of a vitamin E-coated membrane ( VitabranE ViE ) " ex vivo " on mononuclear cells , OxSt , and inflammation-related biochemical and molecular biology markers using a molecular biology approach . p22(phox ) , heme oxygenase (HO)-1 , plasminogen activator inhibitor (PAI)-1 protein level , and phosphorylated extracellular signal-regulated kinase (pERK)1/2 status were evaluated at the beginning of the study , after 6 months and after 12 months by Western blot analysis and oxidized low-density lipoprotein ( OxLDL ) plasma level by enzyme-linked immunosorbent assay , alongside vascular remodeling assessment as measured by carotid intima-media thickness ( IMT ) in a subgroup of nine r and omly selected patients . p22(phox ) , PAI-1 , OxLDL , and pERK all decreased with VitabranE use , while HO-1 increased . Carotid IMT did not increase . Treatment with VitabranE significantly decreases the expression of proteins and markers relevant to OxSt and inflammation tightly associated with cardiovascular disease , and it appears highly likely that VitabranE use will provide a benefit in terms of cardiovascular protection Oxidative stress is increased in hemodialysis ( HD ) patients and contributes to the increased morbidity and mortality in this population . Vitamin E is an antioxidant agent . In the present study the effect of prolonged oral alpha-tocopherol administration on the antioxidant defense system was evaluated . The antioxidant factors plasma total antioxidant status ( TAS ) , red blood cell superoxide dismutase ( SOD ) activity and glutathione peroxidase ( GPX ) activity were evaluated with spectrometry in 27 HD patients . Measurements were performed before and after oral administration of alpha-tocopherol at a dose of 500 mg/d for a one-year period . Twenty HD patients received a placebo and 22 healthy volunteers served as controls .  TAS was increased in HD patients . No difference was detected in SOD and GPX activity between HD patients and healthy volunteers . Tocopherol administration induced a significant decrease in TAS and SOD activity . Levels of GPX activity remained unaffected . All the evaluated factors remained stable in the HD patients receiving a placebo . Prolonged oral alpha-tocopherol administration in HD patients induces a decrease in some components of the antioxidant defense system , raising the possibility for a pro-oxidative role of vitamin E. Vitamin E is an antioxidant agent , but it is also known to have pro-oxidant action under special conditions that can be encountered in HD patients Background : Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of cardiovascular disease and anemia . Vitamin E is a fat-soluble antioxidant that plays a central role in reducing lipid peroxidation and inhibiting the generation of reactive oxygen species . The aim of this cross-over r and omized study was to compare the effects of a vitamin E-coated polysulfone ( Vit E PS ) membrane and a non-vitamin E-coated polysulfone ( PS ) membrane on inflammatory markers and resistance to erythropoietin-stimulating agents ( ESAs ) . Methods : After a 1-month run-in period of st and ard bicarbonate dialysis with a synthetic membrane , 62 patients of both genders , and older than 18 years , dialysis vintage 48 ± 27 months , BMI 22 ± 3 ( from 13 different dialysis units ) were r and omized ( A-B or B-A ) in a cross-over design to Vit E PS ( treatment A ) and to PS ( treatment B ) both for 6 months . C-reactive protein ( CRP ) and interleukin-6 ( IL-6 ) concentrations were determined by a s and wich enzyme immunoassay at baseline and every 2 months ; red blood cell count , ESA dose and ESA resistance index ( ERI ) were assessed monthly . Results : Hemoglobin ( Hb ) levels significantly increased in the Vit E PS group from 11.1 ± 0.6 g/dl at baseline to 11.5 ± 0.7 at 6 months ( p < 0.001 ) and remained unchanged in the PS group . Although ESA dosage remained stable during the observation periods in both groups , ERI was significantly reduced in the Vit E PS group from 10.3 ± 2.2 IU-dl/kg/g Hb week at baseline to 9.2 ± 1.7 at 6 months ( p < 0.001 ) . No significant variation of ERI was observed in the PS group . A significant reduction in plasma CRP and IL-6 levels was observed in the Vit E PS  group : CRP from 6.7 ± 4.8 to 4.8 ± 2.2 mg/l ( p < 0.001 ) and IL-6 from 12.1 ± 1.4 to 7.5 ± 0.4 pg/ml ( p < 0.05 ) . In the PS group , CRP varied from 6.2 ± 4.0 to 6.4 ± 3.7 , and IL-6 from 10.6 ± 2.1 to 9.6 ± 3.5 ( p = n.s . ) . Conclusions : Treatment with Vit E PS membranes seems to lead to a reduction in ESA dosage in HD patients ; in addition , a low chronic inflammatory response may contribute to a sparing effect on exogenous ESA requirements Background : Oxidative stress , a recently identified factor related to the response to erythropoiesis-stimulating agents ( ESAs ) , is increased in hemodialysis patients . The aim of this study was to verify whether ESA responsiveness improves if the anti-oxidant vitamin E ( Vi-E ) is placed on the blood-side layer of a synthetic polysulfone ( PS ) dialyzer . Methods : This 8-month , controlled and open r and omized study involved 2 groups of patients on stable ESA therapy undergoing hemodialysis using a PS dialyzer with or without Vi-E treatment .  Hemoglobin , albumin , high-sensitivity C-reactive protein , interleukin-6 , iron status , parathyroid hormone ( PTH ) , Vi-E ( α- and γ-tocopherol levels ) and the oxidative stress markers , advanced oxidation protein products , carbonyls and advanced glycation end products  were evaluated every 2 months . The primary outcome measure was ESA resistance , the weekly ESA dose divided by the product between hemoglobin level and end-dialysis body weight . Results : Nineteen of the 20 r and omized patients completed the study . During the follow-up , the ESA resistance significantly decreased ( p = 0.024 ) , greater in the Vi-E group ( 37 % ) than in the PS group ( 20 % ) , but this difference was not statistically significant ( p = 0.596 ) . Baseline PTH and Vi-E levels were associated with ESA resistance . In the secondary analysis , including these covariates in the model , the difference between groups in ESA resistance became significant ( p = 0.042 ) . Conclusions : Vi-E placed on the blood-side of a dialyzer may have a possible beneficial effect on ESA resistance in hemodialysis patients ;  baseline PTH levels seem to predict ESA resistance and were useful in showing the possible beneficial effect of Vi-E and should be considered in design ing adequate-sized trials for testing this hypothesis BACKGROUND Atherosclerosis , a major problem in patients on chronic hemodialysis , has been characterized as an inflammatory disease . C-reactive protein ( CRP ) , the prototypical acute phase protein in humans , is a predictor of cardiovascular mortality in the general population . We hypothesize that several of the classic , as well as nontraditional , cardiovascular risk factors may respond to acute phase reactions . An activated acute phase response may influence or predict cardiovascular risk . METHODS In 280 stable hemodialysis patients , serum lipids , apolipoproteins ( apo ) A-I and B , lipoprotein(a ) [ Lp(a ) ] , fibrinogen , and serum albumin ( Salb ) were determined in relation to CRP and serum amyloid A ( SAA ) , two sensitive markers of an acute phase response . Mortality was monitored prospect ively over a two year period . RESULTS Serum CRP and SAA were found to be elevated ( more than 8 and more than 10 mg/liter , respectively ) in 46 % and 47 % of the patients in the absence of clinical ly apparent infection . Patients with elevated CRP or SAA had significantly higher serum levels of Lp(a ) , higher plasma fibrinogen , and lower serum levels of high-density lipoprotein cholesterol , apo A-I , and Salb than patients with normal CRP or SAA . The rise in Lp(a ) concentration was restricted to patients exhibiting high molecular weight apo(a ) isoforms . During follow-up , 72 patients ( 25.7 % ) had died , mostly due to cardiovascular events ( 58 % ) . Overall mortality and cardiovascular mortality were significantly higher in patients with elevated CRP ( 31 % vs. 16 % , P < 0.0001 , and 23 % vs. 5 % , P < 0.0001 , respectively ) or SAA ( 29 % vs. 19 % , P = 0.004 , and 20 vs. 10 % , P = 0.008 , respectively ) and were also higher in patients with Salb of lower than 40 g/liter ( 44 % vs. 14 % , P < 0.0001 , and 34 % vs. 6 % , P < 0.0001 , respectively ) . Univariate Cox regression analysis demonstrated that age , diabetes , pre-existing cardiovascular disease , body mass index , CRP , SAA , Salb , fibrinogen , apo A-I , and Lp(a ) were significantly associated with the risk of all-cause and cardiovascular mortality . During multivariate regression analysis , SAA , fibrinogen , apo A-I , and Lp(a ) lost their predictive values , but age and CRP remained powerful independent predictors of both overall death and cardiovascular death . CONCLUSION These results suggest that a considerable number of hemodialysis patients exhibit an activated acute phase response , which is closely related to high levels of atherogenic vascular risk factors and cardiovascular death . The mechanisms of activated acute phase reaction in patients on chronic hemodialysis remain to be identified . A successful treatment of the inflammatory condition may improve long-term survival in these patients Chronic hemodialysis ( HD ) patients manifest anemia and atherosclerosis with associated oxidative stress . We explored whether intravenous infusion of vitamin C ( VC ) and /or use of vitamin E (VE)-coated dialysis membrane could palliate HD-evoked oxidative stress . Eighty patients undergoing chronic HD were enrolled and r and omly assigned into four groups : HD with intravenous VC ( n=20 ) , HD with VE-coated dialyzer ( n=20 ) , HD with both ( n=20 ) , and HD with neither ( n=20 ) . We evaluated oxidative stress in blood and plasma , erythrocyte methemoglobin/ferricyanide reductase ( red blood cells (RBC)-MFR ) activity , plasma methemoglobin , and pro-inflammatory cytokines in these patients . All patients showed marked increases ( 14-fold ) in blood reactive oxygen species ( ROS ) after HD . The types of ROS were mostly hydrogen peroxide , and in lesser amounts , O2 * - and HOCl . HD result ed in decreased plasma VC , total antioxidant status , and RBC-MFR activity and increased plasma and erythrocyte levels of phosphatidylcholine hydroperoxide ( PCOOH ) and methemoglobin . Intravenous VC significantly palliated HD-induced oxidative stress , plasma and RBC levels of PCOOH , and plasma methemoglobin levels and preserved RBC-MFR activity . The VE-coated dialyzer effectively prevented RBCs from oxidative stress , although it showed a partial effect on the reduction of total ROS activity in whole blood . In conclusion , intravenous VC plus a VE-coated dialyzer is effective in palliating HD-evoked oxidative stress , as indicated by hemolysis and lipid peroxidation , and by overexpression of proinflammation cytokines in HD patients . Using VE-coated dialyzer per se is , however , effective in reducing lipid peroxidation and oxidative damage to RBCs BACKGROUND In the present prospect i ve , controlled , observational cohort study , we investigated the effects of the use of a vitamin E-coated membrane dialyser ( VEM ) on markers of chronic inflammation , oxidative stress and endothelial cell apoptosis in end-stage renal disease ( ESRD ) patients on chronic haemodialysis ( HD )  , as long as evidence of their effects on these pathogenetic routes are inconclusive as yet , despite 
    Output:
    
CONCLUSIONS Vitamin E-coated dialyzer can reduce the oxidative stress and inflammation status reflected by the decreasing of serum TBARS , oxLDL , CRP , and IL-6 levels , and this new dialyzer does not affect the dialysis adequacy