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.