Microbiologic Purity of Dialysate:Rationale and Te chnical Aspects

Canaud, Bernard; Bosc, J. Y.; Leray, Hélène; Moréna, Marion; Stec, F.

doi:10.1159/000014419

Cited by 44 publications

(29 citation statements)

References 48 publications

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“…In agreement with previous studies, this suggests that hemodialysis water, even with acceptable levels of bacterial contamination, is capable of inducing inflammatory activity (27,28), although this subject is still being debated (29,30). Schiffl and colleagues (31) demonstrated that the use of ultrapure water leads to the improvement of inflammatory and nutritional parameters.…”

Section: Discussionsupporting

confidence: 89%

Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients

Thomé

Senger

Garcez

et al. 2005

Braz J Med Biol Res

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Atherosclerosis is a major complication of chronic renal failure. Microinflammation is involved in atherogenesis and is associated with uremia and dialysis. The role of dialysate water contamination in inducing inflammation has been debated. Our aim was to study inflammatory markers in patients on chronic dialysis, before and 3 to 6 months after switching the water purification system from deionization to reverse osmosis. Patients had demographic, clinical and nutritional information collected and blood drawn for determination of albumin, ferritin, C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-α in both situations. Acceptable levels of water purity were less than 200 colony-forming units of bacteria and less than 1 ng/ml of endotoxin. Sixteen patients died. They had higher median CRP (26.6 vs 11.2 mg/dl, P = 0.007) and lower median albumin levels (3.1 vs 3.9 g/l, P < 0.05) compared to the 31 survivors. Eight patients were excluded because of obvious inflammatory conditions. From the 23 remaining patients (mean age ± SD: 51.3 ± 13.9 years), 18 had a decrease in CRP after the water treatment system was changed. Overall, median CRP was lower with reverse osmosis than with deionization (13.2 vs 4.5 mg/l, P = 0.022, N = 23). There was no difference in albumin, cytokines, subjective global evaluation, or clinical and biochemical parameters. In conclusion, uremic patients presented a clinically significant reduction in CRP levels when dialysate water purification system switched from deionization to reverse osmosis. It is possible that better water treatments induce less inflammation and eventually less atherosclerosis in hemodialysis patients.

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Section: Discussionsupporting

confidence: 89%

Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients

Thomé

Senger

Garcez

et al. 2005

Braz J Med Biol Res

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“…The latter is one of the major components of the hemocompatibility network in HD patients and is identified as a risk factor in the dialysis-related pathology [17]. OL HDF uses ultrapure dialysate and reinfusate with the aim of sterility and apyrogenicity and thus contributes to a reduced proinflammatory cytokine production, improving anemia.…”

Section: Discussionmentioning

confidence: 99%

“…On-line preparation of intravenous substitution fluid is a safe procedure, as it gives access to virtually unlimited amounts of a sterile and nonpyrogenic solution [17]. Moreover on-line-prepared dialysate and reinfusate for HDF can be considered safe regarding trace elements and micropollutants [18]; large volumes of reinfusate do not affect the plasma levels of trace elements [19].…”

Section: Introductionmentioning

confidence: 99%

Improvement of Anemia in Hemodialysis Patients Treated by Hemodiafiltration with High-Volume On-Line-Prepared Substitution Fluid

Bonforte¹,

Grillo²,

Zerbi³

et al. 2002

Blood Purif

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Background: Hemodiafiltration (HDF) is associated with a lower incidence of neuropathy, carpal tunnel syndrome, joint pain, and partial correction of anemia. HDF with on-line-prepared substitution fluid (OL HDF), as compared with conventional hemodialysis, increases the treatment tolerance and, as compared with standard HDF, avoids storage problems and allows a higher substitution volume at low cost. Methods: Thirty-two hemodialysis patients treated by OL HDF for at least 9 months were studied. Hemoglobin, hematocrit, iron metabolism, serum albumin, dialysis dose and dry body weight were determined under a settled condition with regular hemodialysis 3 months before the transfer to OL HDF. The same parameters were analyzed 3, 6 and 9 months after the beginning of the new treatment modality. Results: During OL HDF, hemoglobin values significantly increased in patients without addition of recombinant human erythropoietin (rHuEPO): baseline vs. 6 months 11 ± 1.7 vs. 12 ± 1.8 g/dl (p < 0.01); baseline vs. 9 months 11 ± 1.7 vs. 12 ± 1.6 g/dl (p < 0.05). In patients on a maintenance dose of rhuEPO, this could be significantly reduced, while the target hemoglobin levels were maintained (10.6 ± 0.9 g/dl): baseline 99.8 ± 50.4 U/kg/week, 3rd month 76.2 ± 43 U/kg/week, 6th month 64.3 ± 37 U/kg/week, and 9th month 59.4 ± 38.6 U/kg/week (p = 0.007, p = 0.0006, and p = 0.0007, respectively, vs. baseline). Iron metabolism, dialysis dose, dry body weight and serum albumin levels did not significantly change during the follow-up period. Further, a stability of the rHuEPO supplementation was observed in 14 patients followed up for 24 months. Conclusions: OL HDF influences anemia and rHuEPO dose. It allows considerable anemia correction in patients without rHuEPO treatment, while it significantly reduces rHuEPO doses in those on rHuEPO treatment as compared with standard hemodialysis. The rHuEPO costs are consequently reduced.

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“…At the time of data collection, all patients were treated by a sterile and nonpyrogenic dialysis fluid containing less than 100 colony forming units per liter (CFU/l), and less than 0.025 endotoxin units per ml (EU/ml) [10]. …”

Section: Methodsmentioning

confidence: 99%

Advanced Glycation End Products and β<sub>2</sub>-Microglobulin as Predictors of Carpal Tunnel Syndrome in Hemodialysis Patients

et al. 2012

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Background/Aims: Carpal tunnel syndrome (CTS) is a common clinical presentation of dialysis-related amyloidosis. It was determined whether β₂-microglobulin (β2M) and advanced glycation end products in serum are predictors of CTS in dialysis patients. Methods: A total of 385 hemodialysis patients were screened for CTS. β2M in serum was determined by a competitive enzyme-linked immunoassay, CML by a competitive enzyme-linked immunosorbent assay and total pentosidine by reverse-phase high-performance liquid chromatography. Results: 127 patients (33%) were treated with biocompatible membranes, 174 (45%) with high-flux dialysis. 122 patients (31.7%) had clinical signs of CTS. Significant predictors of CTS were: age, female gender, serum β2M, total protein, dialysis with non-biocompatible high-flux dialysis compared to non-biocompatible low-flux dialysis, Kt/V and serum concentration of CML (OR 2.47 for the 3rd vs. 1st quartile, 95% CI 1.229–4.961, p = 0.011). Conclusion: The prevalence of CTS as a possible manifestation of dialysis-related amyloidosis is still high. Serum concentration of CML may be a predictor of CTS besides β2M and malnutrition.

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Microbiologic Purity of Dialysate:Rationale and Te chnical Aspects

Cited by 44 publications

References 48 publications

Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients

Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients

Improvement of Anemia in Hemodialysis Patients Treated by Hemodiafiltration with High-Volume On-Line-Prepared Substitution Fluid

Advanced Glycation End Products and β<sub>2</sub>-Microglobulin as Predictors of Carpal Tunnel Syndrome in Hemodialysis Patients

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