Use of ultrapure dialysate in reduction of chronic inflammation during hemodialysis

Blood Purif. 2004;22 Suppl 2:26-9. doi: 10.1159/000081870.

Abstract

Chronic inflammation contributes to the pathogenesis of several complications of hemodialysis therapy. It is thought that backfiltration of bacteria-derived contaminations during dialysis may induce a chronic inflammatory state. High-sensitivity C-reactive protein (hs-CRP) is one of the tools which can take a hold on such a chronic inflammatory condition. We examined the effect of ultrapure dialysate which contributes to chronic inflammation with hs-CRP and tried to reduce endotoxin (ET) levels at the end of the dialysate from 70 EU/l to <1.0 EU/l (ultrapure dialysate). Other dialysis conditions, except ET level, were fixed. We investigated the hs-CRP of 23 patients receiving regular dialysis before the use of ultrapure dialysate and 1 year after use of it prospectively. The data showed a significant decrease in the median value of the hs-CRP from 0.16 to 0.07 mg/dl (p < 0.05). The value of serum beta(2)-microglobulin decreased from 33.2 to 28.4 mg/dl (p < 0.01) and the hemoglobin level increased from 10.0 to 11.0 g/dl (p < 0.05). These results indicate that even a dialysate containing 70 EU/l of ET level may induce a chronic inflammatory state. hs-CRP is a very useful marker of chronic inflammation and the use of ultrapure dialysate is necessary to improve a chronic inflammatory state. The targeted ET level at the end of the dialysate should be set at < or = 1.0 EU/l.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • C-Reactive Protein / analysis
  • Chronic Disease
  • Dialysis Solutions / standards*
  • Endotoxins / analysis
  • Female
  • Hemoglobins / analysis
  • Humans
  • Inflammation / etiology
  • Inflammation / prevention & control*
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality Control
  • Renal Dialysis / adverse effects*
  • Sterilization
  • beta 2-Microglobulin / blood

Substances

  • Dialysis Solutions
  • Endotoxins
  • Hemoglobins
  • beta 2-Microglobulin
  • C-Reactive Protein