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Low plasma α-tocopherol concentrations and adverse clinical outcomes in diabetic hemodialysis patients.

Clinical journal of the American Society of Nephrology : CJASN (2013-01-22)
Katharina M Espe, Jens Raila, Andrea Henze, Katja Blouin, Andreas Schneider, Daniel Schmiedeke, Vera Krane, Stefan Pilz, Florian J Schweigert, Berthold Hocher, Christoph Wanner, Christiane Drechsler

Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of α-tocopherol and specific clinical outcomes in diabetic hemodialysis patients. In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), α-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma α-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508). Patients had a mean age of 66±8 years, and mean plasma α-tocopherol level was 22.8±9.6 µmol/L. Levels of α-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients in the lowest α-tocopherol quartile had (in unadjusted analyses) a 79% higher risk of stroke and a 31% higher risk of all-cause mortality compared with patients in the highest quartile. The associations were attenuated after adjustment for confounders (hazard ratiostroke=1.56, 95% confidence interval=0.75-3.25; hazard ratiomortality=1.22, 95% confidence interval=0.89-1.69, respectively). There was no association between α-tocopherol and myocardial infarction, sudden death, or infectious death. Plasma α-tocopherol concentrations were not independently associated with cardiovascular outcomes, infectious deaths, or all-cause mortality in diabetic hemodialysis patients. The lack of association can partly be explained by a confounding influence of malnutrition, which should be considered in the planning of trials to reduce cardiovascular risk in dialysis patients.

Product Number
Product Description

(+)-α-Tocopherol, from vegetable oil, Type V, ~1000 IU/g
DL-α-Tocopherol acetate, ≥96% (HPLC)
(+)-α-Tocopherol, Type VI, from vegetable oil, liquid (≥0.88M based on potency, density and molecular wt.), BioReagent, suitable for insect cell culture, ≥1000 IU/g
DL-α-Tocopherol acetate, tested according to Ph. Eur.
Tocopheryl Acetate, a, Pharmaceutical Secondary Standard; Certified Reference Material
α-Tocopherol acetate, European Pharmacopoeia (EP) Reference Standard