Use of Ultrapure Dialysate in Reduction of Chronic Inflammation during Hemodialysis

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 β₂-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 ≤1.0 EU/l.

Role of Residual Kidney Function and Convective Volume on Change in β2-Microglobulin Levels in Hemodiafiltration Patients

“…Adsorption to the dialyzer membrane partly contributes to ␤2M removal (26) and may also differ between various types of dialyzers (27). In addition, the use of ultrapure dialysis fluid has been associated with lower ␤2M concentrations, possibly because of a decreased inflammatory response and subsequent decreased ␤2M production (28)(29)(30). In this study, HD and HDF patients were treated with synthetic biocompatible dialyzers and only ultrapure dialysis fluids were used.…”

IL-1β Receptor Antagonist Reduces Inflammation in Hemodialysis Patients

“…9 -11 Chronic inflammation in ESRD is highly prevalent and multifactorial. 7 Some of the most commonly postulated etiologies include dialysis-related factors such as the extracorporeal circulation, 12 the quality of the dialysate, 13 the biocompatibility of the hemodialysis membranes, acute and chronic access thrombosis, and dialysis catheters. 7 Non-dialysis-related factors include decreased clearance and increased production of cytokines, retention of uremic solutes, increased oxidative stress burden, 14 genetic factors, and high prevalence of comorbidities associated with inflammation.…”

On-Line Hemodiafiltration Reduces the Proinflammatory CD14+CD16+ Monocyte-Derived Dendritic Cells

“…Use of synthetic membranes and production of ultrapure dialysate have been proved to have an impact on improving treatment biocompatibility and reducing the chronic inflammatory state (13)(14)(15). It still is not clear whether high convective transport may have a role in modulating the mechanisms that are involved in inflammation in HD patients (16).…”