Gum Arabic as Antioxidant and Anti-inflammatory in Hemodialysis Patients
Gum Arabic as Antioxidant and Anti-inflammatory in Hemodialysis Patients
Oxidative processes increased in patients with renal failure and especially patients with end
 stage renal failure on dialysis. Oxidative stress plays a role in renal damage and also on
 cardiovascular disease, atherosclerosis, which can accelerate renal damage. Gum Arabic is
 claimed to have antioxidant effect and this will decrease the harmful effect of the free
 radical on patient on hemodialysis. In this study investigators are aiming to see the effect
 of Gum Arabic on Oxidative Stress and inflammatory markers in patients on regular
 hemodialysis.
The oxidative stress reflects an imbalance between the systemic manifestation of reactive
 oxygen species and a biological system's ability to readily detoxify the reactive
 intermediates or to repair the resulting damage.

 Cells continuously produce free radicals and reactive oxygen species (ROS) as part of
 metabolic processes. These free radicals are neutralized by an elaborate antioxidant defense
 system consisting of enzymes such as catalase, superoxide dismutase, glutathione peroxidase,
 and numerous non-enzymatic antioxidants, including vitamins A, E and C and glutathione.

 Oxidative stress has been linked to the pathogenesis of a variety of diseases, such as renal
 disease, cardiovascular disease, atherosclerosis, hypertension, cancer, diabetes, arthritis
 neurodegenerative diseases (i.e., Alzheimer's and Parkinson's disease), and aging.

 The prevalence and incidence of patient suffering from chronic renal failure is increasing
 worldwide and locally in Sudan(5). Several publication suggest that oxidative processes may
 be increased in patients with renal failure. As oxidative stress plays a role in renal damage
 it offers a potential target for therapeutic intervention.

 There is a lot of factors that can lead to oxidative stress in patients with chronic kidney
 disease (CKD) . Intravenous administration of iron is widely prescribed in patients with
 chronic kidney disease (CKD) and can cause oxidative stress.Hemodialysis is often used for
 removal of excessive toxins, metabolic products, and blood components from patients with
 end-stage renal diseases (ESRD). Clinical studies have confirmed that hemodialysis (HD) is
 associated with the development of oxidative stress and disturbance in the enzyme systems
 that protect against oxygen free radicals.

 The major cause of mortality in patients with end-stage renal failure receiving renal
 replacement therapy is cardiovascular disease . Cardiovascular disease (CVD) is the cause of
 death in 34% of hemodialysis (HD) patients. Increased lipid peroxidation and depletion of
 chain- breaking antioxidants may contribute to increased risk of atherosclerosis.

 Antioxidants have been used as therapies to decrease oxidative stress and improve CVD risk in
 hemodialysis (HD) Patients .Many studies investigated the effects of antioxidant therapies on
 biomarkers of oxidative stress or clinical outcomes. The majority were small trials using a
 nonrandomized open-label design with a single HD group (no HD controls). The antioxidant used
 were Alpha-tocopherol , vitamin c decreased oxidative stress and N-acetylcysteine .
 N-acetylcysteine was the most efficacious agent. Others studies have used a combination of
 antioxidants that decreased oxidative stresses. Most of these intervention studies were done
 in HD patients .

 Gum arabic is defined by the FAO/WHO Joint Expert Committee for Food Additives (JECFA) as 'a
 dried exudation obtained from the stems of Acacia Senegal tree or closely related species of
 Acacia (family Leguminosae).

 GA is indigestible for both human and animals; Its fermentation by colonic intestinal
 bacteria leads to formation of various degradation products, such as short-chain fatty acids
 .Gum Arabic ingestion increases serum short chain fatty acid concentration, mainly butyrate
 and propionate. Serum butyrate concentration increased following administration of GA in
 healthy subjects. Oral intake of GA has been shown to provide several health benefits, such
 as prebiotic effects. GA significantly increases Bifidobacteria, Lactobacteria, and
 Bacteriodes in the gut. GA is claimed to have anti-cancer ,anti-malarial immune-modulatory
 and antioxidant effects. GA treatment has been shown to favorably influence clinical and
 laboratory results in rats with adenine-induced chronic renal failure CRF and in humans
 diagnosed with renal failure, reported that GA was able to decrease high levels of several
 pro-inflammatory cytokines in plasma and kidney of rats suffering from adenine-induced CRF.

 The antioxidant effect of Gum Arabic has been observed in Number of published data .

 More recently 2017 reported more evidence that GA has potent anti- oxidative effects in
 humans as demonstrated by its ability to increase TAC and to decrease oxidative stress
 markers in humans, Almost all previous studies were conducted in animal models or in vitro
 studies except the last one(17) . the increased intake of dietary antioxidants from GA may
 help to maintain an adequate antioxidant defense status . GA can be utilized in other
 clinical conditions and diseases caused by increased lipid peroxidation and tissue injury.

 In this study investigators are aiming to see the effect of Gum Arabic on Oxidative Stress
 and inflammatory markers in patients on regular hemodialysis.
Inclusion Criteria:

 -  End stage renal disease patients on regular hemodialysis.

 Exclusion Criteria:

 -  Patient known have ischemic heart disease (coronary artery disease),

 -  Pregnant women,

 -  Patient who have impaired liver function or hepatitis VIRUS positive,

 -  Patient who HIV positive and patient currently use of GUM Arabic.