The effect of reduced L-glutathione supplementation on TNF-α, hs-CRP, and neutrophil-lymphocyte ratio in maintenance hemodialysis patients

R. Supriyadi, M. Chandra, A. Makmun, I. Wijaya, R. Bandiara, R. Wisaksana

Department of Internal Medicine, Faculty of Medicine, Universitas Padjajaran, Division of Nephrology, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. rudi.supriyadi@unpad.ac.id

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• Nephrology

OBJECTIVE: Cardiovascular disease is the main cause of mortality in patients with chronic kidney disease stage 5 on dialysis (CKD-5D). High sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and neutrophil-lymphocyte ratio (NLR) are several inflammatory parameters associated with high cardiovascular events in CKD-5D. The main aim of this study was to evaluate the effect of reduced L-glutathione supplementation on serum hs-CRP, TNF-α, and NLR in patients with CKD-5D.

PATIENTS AND METHODS: This study is a quasi-experimental research with one group pretest-posttest design. Subjects included were patients with CKD-5D who routinely underwent hemodialysis therapy two times a week in Hasan Sadikin General Hospital. Serum hs-CRP, TNF-α, and NLR levels were obtained before and after the intervention of reduced L-glutathione supplementation dosing of one thousand milligrams a day for four weeks. Statistical analysis was then conducted using the Wilcoxon test.

RESULTS: There were 26 hemodialysis patients included in the study, with a median age of 43 years and a male predominance. There was a significant decrease in serum TNF-α level after reduced L-glutathione supplementation for 4 weeks, 5.40 (-10.80-0.00) pg/mL, p = 0.002. However, there was no statistically significant decrease in either serum hs-CRP level, 0.40 (-0.70-0.80) mg/L (p = 0.656), or NLR with a difference of 0.55 (0.30-1.00) p = 0.055.

CONCLUSIONS: Exogenous oral reduced glutathione supplementation for four weeks significantly reduced TNF-α level, but no significant decrease in hs-CRP level and NLR in patients with CKD-5D.

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