Anti‐Oxidative Capacity, but Not Oxidative Burden, Predicts Mortality Among Patients With End‐Stage Kidney Disease

PURPOSE: Oxidative stress is a key driver of chronic kidney disease and its complications. However, integrative measures capturing the oxidative burden and anti-oxidative defense remain under-explored as prognostic tools. We investigated whether composite oxidative (OxyScore) and anti-oxidative (Anti-OxyScore) indices are associated with mortality in patients undergoing maintenance hemodialysis. METHODS: We analyzed a prospectively established multicentric cohort of patients with end-stage kidney disease (ESKD) receiving chronic hemodialysis. Comprehensive clinical, biochemical, and functional data were collected. Composite oxidative and anti-oxidative indices were derived from predefined biomarker panels. Patients were stratified into high and low OxyScore or Anti-OxyScore groups. Cox proportional hazards models were used to evaluate associations between OxyScore, Anti-OxyScore, and all-cause mortality. RESULTS: Totally 145 patients were included, with comparable baseline characteristics between groups. During follow-up, high Anti-OxyScore was independently associated with increased mortality risk (adjusted hazard ratio [aHR] 1.916, 95% confidence interval [CI] 1.119-3.281), whereas OxyScore was not significantly associated with mortality after adjustment (aHR 2.100, 95% CI 0.820-5.380). CONCLUSION: Anti-oxidative capacity, rather than oxidative burden alone, independently predicts mortality in patients with ESKD. These findings underscore the prognostic relevance of impaired anti-oxidative defense and support the use of composite anti-oxidative indices as clinically meaningful biomarkers in this population.