ABO Blood Groups Modulate Oxidative Stress in Hemodialysis Patients

End stage renal disease (ESRD) , oxidative stress and persistent inflammation are factors that lead to cardiovascular morbidity. ABO  blood group phenotypes affect inflammatory and thrombotic pathways, it is unknown how they relate to oxidative biomarkers in hemodialysis (HD). To compare inflammatory and oxidative stress indicators in maintenance HD patients with various ABO genotypes . At Kirkuk General Hospital in Iraq , 230 maintenance HD patients more than 6 months dialysis, ages 22–70) and 70 matched healthy controls participated in this cross-sectional study between April and November 2023.  Validated techniques were used to evaluate serum levels of MDA, reduced glutathione (GSH), catalase activity, high sensitivity C-reactive protein (hs -CRP), interleukin- 6 (IL-6), and tumor necrosis factor-alpha (TNF-α).  ANOVA with Bonferroni correction and multiple linear regression with adjustments for age, sex, dialysis vintage, Kt/V, hemoglobin, albumin, and comorbidities were among the statistical analyses. Compared to group O (n= 92), non O phenotypes (A, B, AB; n= 138) exhibited substantially reduced GSH (5.05±1.40 vs. 5.84±1.25 µmol/mL, p= 0.001, d= 0.59), hs-CRP (6.73±2.76 vs. 5.02±2.34 mg/L, p=0.001, d=0.67), and MDA (3.57±0.80 vs. 2.94±0.65 nmol/mL, p<0.001, Cohen’s d=0.87).  The non-O phenotype independently predicted lower GSH (β=−0.64, 95%CI −1.08 to −0.20, p=0.005) and higher MDA (β=0.58, 95%CI 0.32–0.84, p<0.001) after multivariate adjustment.  MDA showed a correlation with both IL-6 (r=0.24, p=0.011) and hs-CRP (r=0.28, p=0.003). Oxidative stress in HD patients is independently modulated by ABO blood types; non-O phenotypes show 21% greater lipid peroxidation.  In ESRD , ABO type may improve cardiovascular risk assessment.  It is necessary to do prospective research relating ABO oxidative characteristics to clinical outcomes.