Conventional versus ultrapure dialysate for lowering serum lipoprotein(a) levels in patients on long-term hemodialysis: a randomized trial.
OBJECTIVE
In patients on long-term hemodialysis, high lipoprotein(a) [Lp(a)] levels are difficult to lower with medications, although they remain a risk factor for cardiovascular disease. We investigated whether ultrapure dialysate (UPD) could lower Lp(a).


METHODS
We randomly assigned patients stabilized on long-term dialysis to either a low-flux synthetic polysulphone membrane (the UPD group; n=14) or to a conventional dialysate (the CD group; n=13). Blood samples were collected 1 week before dialysis and 1 week, 1 month, 6 months and 12 months after dialysis; Lp(a) was measured by the immunoturbidimetry method. Hemoglobin, interleukin-6, hypersensitive C-reactive protein, beta(2) microglobulin and albumin were also measured. The erythropoietin dosage, Kt/V, and normalized protein catabolic rate were recorded monthly.


RESULTS
At 12 months, mean (SD) serum levels of Lp(a) in the CD patients increased from 143.46 (125.11) to 283.89 (145.81) mg/L (p<0.01), whereas levels in the UPD group remained unchanged: 131.38 (201.45) to 120.90 (122.11) mg/L. Endotoxin levels in the 10 CD patients who completed the study ranged from 0.116 to 0.349 EU/mL and were undetectable in the 11 UPD patients who completed the study. The cultures were less than 200 CFU/mL in CD patients and negative all the time for all UPD patients. Changes in Lp(a) from baseline values were lower in the UPD group than in the CD group (p<0.05). However, changes in other variables did not differ between groups.


CONCLUSIONS
Ultrapure dialysate can prevent the rise of Lp(a), potentially decreasing the risk of cardiovascular disease in hemodialysis patients.
Tao
Jianling
J
Division of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Sun
Yang
Y
Li
Xuemei
X
Li
Hang
H
Liu
Shiqin
S
Wen
Yubing
Y
Duan
Lin
L
Li
Yan
Y
Li
Xuewang
X
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D015536:Down-Regulation; D004731:Endotoxins / Q000097:blood; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D015312:Hemodialysis Solutions / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011108:Polymers; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism; D013450:Sulfones; D013997:Time Factors; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000097:blood
D015415:Biomarkers; D004731:Endotoxins; D006397:Hematinics; D015312:Hemodialysis Solutions; D006454:Hemoglobins; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D017270:Lipoprotein(a); D008567:Membranes, Artificial; D011108:Polymers; D011994:Recombinant Proteins; D012709:Serum Albumin; D013450:Sulfones; D001613:beta 2-Microglobulin; D004921:Erythropoietin; C017662:polysulfone P 1700; D002097:C-Reactive Protein