title: Ultrapure dialysate improves iron utilization and erythropoietin response in chronic hemodialysis patients - a prospective cross-over study.
abstract: 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 (rHuEPO) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Po-Yaur
authors.initials: PY
authors.lastname: Hsu
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
authors.forename: Chun-Chen
authors.initials: CC
authors.lastname: Yu
authors.forename: Chu-Chun
authors.initials: CC
authors.lastname: Chien
authors.forename: Tian-Gu
authors.initials: TG
authors.lastname: Hsiau
authors.forename: Ten-Hui
authors.initials: TH
authors.lastname: Sun
authors.forename: Lan-Mei
authors.initials: LM
authors.lastname: Huang
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D018592:Cross-Over Studies; D004731:Endotoxins / Q000032:analysis; D004921:Erythropoietin / Q000494:pharmacology*; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006801:Humans; D007501:Iron / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D006435:Renal Dialysis; D014462:Ultrafiltration
chemical_list: D004731:Endotoxins; D015312:Hemodialysis Solutions; D011994:Recombinant Proteins; D004921:Erythropoietin; D002097:C-Reactive Protein; D007501:Iron