Use of ultrapure dialysate in reduction of chronic inflammation during hemodialysis.
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.
Arizono
Kenji
K
Department of Nephrology, Kumamoto Chuo Hospital, Kumamoto, Japan. k-arizono@kumachu.gr.jp
Nomura
Kazufumi
K
Motoyama
Takeshi
T
Matsushita
Yoshio
Y
Matsuoka
Kiyoshi
K
Miyazu
Rikako
R
Takeshita
Hisako
H
Fukui
Hiroyoshi
H
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D015314:Dialysis Solutions / Q000592:standards*; D004731:Endotoxins / Q000032:analysis; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011786:Quality Control; D006435:Renal Dialysis / Q000009:adverse effects*; D013242:Sterilization; D001613:beta 2-Microglobulin / Q000097:blood
D015314:Dialysis Solutions; D004731:Endotoxins; D006454:Hemoglobins; D001613:beta 2-Microglobulin; D002097:C-Reactive Protein