***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 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 In hemodialysis patients , oxidative stress results from an imbalance between the production of reactive oxygen species and antioxidant defense mechanisms . Recently , a new dialysis multi‐‐layer membrane has been developed , by modifying the inner surface of regenerated cellulose to support a vitamin E coating . The aim of our study was to investigate the effects of hemodialysis treatment with vitamin E‐‐modified membrane on anemia and erythropoietin requirement in a group of chronic uremic patients . Ten uremic , non diabetic , patients on st and ard bicarbonate dialysis were treated with vitamin E‐‐bonded dialysis membrane for 12 months . Hematological parameters , erythropoietin requirement , serum vitamin E and serum malonyldialdehyde ( ( MDA ) ) were evaluated before starting the study and monthly . No significant changes in hemoglobin level , RBC count , hematocrit and EPO requirement were observed . Basal vitamin E levels were in the normal range ( ( 13.0±2.88 mg//L vs. 14.79±3.12 mg//L ; NS ) ) . On the contrary , basal MDA levels were higher than those observed in the control group ( ( 1.87±0.36 vs. 1.13±0.18 mmol//mL ; p < 0.01 ) ) and a significant decrease of MDA levels was found after 1 month of Excebrane ® treatment ( ( 1.39±0.25 nmol//mL ; p < 0.02 ) ) . In conclusion , the role of the “ oxidative hemolysis ” in the pathogenesis of anemia in CHD patients is still not clearly defined , but it could be of minor clinical relevance . Although the effectiveness of vitamin E‐‐coated membranes as a scavenger of ROS allows a better control of intradialytic oxidative stress , it does n't seem to contribute to clinical management of anemia in these patients 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 In hemodialysis patients the activity of stimulated Th1 lymphocytes is depressed , while Th2 cells are constitutively primed . Such phenomena may depend on monocyte activation and altered release of interleukin (IL)-12 and IL-18 , which regulate Th cell differentiation . Reactive oxygen species ( ROS ) activate monocytes ; therefore , a hemodialyzer with antioxidant activity would contrast ROS , prevent monocyte activation , reset IL-12 and IL-18 release , and restore Th1/Th2 balance . METHODS Ten patients on regular dialysis treatment ( RDT ) with cellulosic membrane ( CM )  were shifted to vitamin E-coated dialyzer ( VE ) . During treatment with CM and after 3 , 6 , and 12 months of treatment with VE , peripheral blood mononuclear cells ( P BMC ) and purified CD4 + cells were isolated , and cultured , resting , mitogen-stimulated , and interferon gamma ( IFNgamma ) , IL-4 , IL-10 , IL-12 , and IL-18 release was measured . Vitamin E and A plasma levels and the effects of a single dialysis session on peripheral blood NO levels were assayed . RESULTS The constitutive release of IL-4 and IL-10 by CD4 + cells was abated significantly by treatment with VE ( nadir -77.8 % and -55.3 % , respectively , at 12 months ) . INFgamma release by mitogen-stimulated CD4 + recovered with VE ( zenith + 501 % at 12 months ) . P BMC constitutive production of IL-12 and IL-18 was significantly reduced by VE ( nadir at 12 months -64.7 % and -51.3 % , respectively ) . VE increased plasma levels of vitamins E and A. NO plasma levels fell after a single dialysis treatment with VE ( -17 % , P < 0.05 ) in contrast with CU ( + 27.1 % , P < 0.05 ) . CONCLUSION The network of cytokines released by monocytes and Th cells is reset toward normality by treatment with vitamin E-coated dialyzer BACKGROUND Oxidative stress has emerged as a strong pathogenic cofactor implicated in the development of long-term complications in hemodialysis ( HD ) patients , such as anemia , and as a major component of the malnutrition inflammation complex syndrome . This prospect i ve multicenter study aim ed at evaluating the short-term effects of the new vitamin E (vitE)-coated polysulfone ( PS ) membrane ( VitabranE ) on biocompatibility performances and anemia in HD patients . METHODS After a 3-month washout period with a high-flux synthetic dialyzer , 43 HD patients were switched to a vitE-PS dialyzer .  Sampling was performed at baseline ( corresponding to the end of the washout period ) and after 1 , 2 and 3 months of treatment . Oxidative stress status , as well as inflammatory parameters , was investigated at the end of each study period . Hemoglobin levels and administered doses of recombinant human erythropoietin or epoetin ( EPO ) were available in each center . RESULTS The use of vitE-coated membranes for 3 months was not associated with any change in inflammatory parameters . By contrast , vitE-PS dialyzer result ed in a progressive increase in red blood cell ( RBC ) vitE concentration and in RBC superoxide dismutase activity . A concomitant progressive significant decrease in advanced oxidation protein product concentration at 2 months was observed , suggesting a preventive effect on oxidative stress . Finally , a significant decrease of the erythropoietin resistance index was obtained after 3 months of treatment . CONCLUSIONS Use of the vitE-PS membrane during a short period improves erythrocyte antioxidant defense mechanisms and seems to lead to a reduction in EPO requirements in HD 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 ( PCO 
    Output:
    
ViE-m significantly improved the Erythropoietin Resistance Index but had no impact on other anemia parameters .
As for oxidative stress and inflammation , ViE-m produced a significant decrease in interleukin-6 levels , thiobarbituric acid reactive substances , plasma and red blood cell ( RBC ) malonylaldehyde and a significant increase in blood and RBC vitamin E. Conversely , ViE-m use had no impact on lipid profile , dialysis adequacy , blood pressure , albumin and uric acid .
Conclusions : ViE-m might ameliorate anemia management by reducing oxidative stress and inflammation .