Ultrapure dialysate improves iron utilization and erythropoietin response in chronic hemodialysis patients - a prospective cross-over study
Hsu, P-Yaur.; Lin, C-Liang.; Yu, C-Chen.; Chien, C-Chun.; Hsiau, T-Gu.; Sun, T-Hui.; Huang, L-Mei.; Yang, C-Wei.
Journal of Nephrology 17(5): 693-700
2004
ISSN/ISBN: 1121-8428 PMID: 15593037 Document Number: 569507
Background. The impact of ultrapure dialysis on dialysate-related chronic inflammatory status and anemia in uremic patients on maintenance hemodialysis (HD) remains uncertain. We evaluated ultrapure dialysate effects on erythropoietin (EPO) response and inflammatory status in a prospective, randomized, cross-over study. Methods: Thirty-four HD patients were divided into two groups. One group was treated with conventional dialysate and the other group with ultrapure dialysate for 6 months and crossed over for another 6 months. Bacteria growth and dialysate endotoxin were examined. Parameters including C-reactive protein (CRP), recombinant human erythropoietin (rHuE-PO) dose, ferritin, iron saturation and serum albumin were measured at the start, and at 6 and 12 months. Results. The endotoxin levels reduced significantly in the ultrapure dialysate by adding a dialysate ultrafilter. After a 6-month treatment with ultrapure dialysate, there were statistically significant differences in the systemic inflammation markers between both groups. Changing from conventional to ultrapure dialysis fluid significantly reduced CRP (7.01 5.059 to 4.461 +/- 3.754 mg/L, p<0.05), and resulted in reduced rHuEPO doses (12500+/-7060 to 10440+/-7050 U/month, p<0.05). Continuous conventional dialysate use was not associated with significant alternations in CRP (from 5.849+/-7.744 to 6.187+/-7.997 mg/L, p=0.456) and rHuEPO dose (14060+/-6210 to 15060+/-7250U/month, p>0.05). The ferritin level reduced significantly (422+/-183 to 272+/-162 mcg/L, p<0.05) in the ultrapure dialysate group. After another 6-month cross-over, the study parameters were reversed among the two groups indicating the beneficial effect of ultrapure dialysis. Conclusion: Through endotoxin reduction in conventional dialysate, ultrapure dialysis in dialysis patients manifested a reduced inflammatory parameter, reduced rHuEPO dose and improved iron utilization; and therefore, could be beneficial in anemia treatment.