title: Effect of ultrapure dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters: a meta-analysis.
abstract: BACKGROUND
  Markers of inflammation are linked to malnutrition and confer an increased mortality risk in hemodialysis patients. Ultrapure dialysate might have a beneficial effect on markers of inflammation. We conducted a meta-analysis that examined the effect of ultrapure versus standard dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters.
  
  
  METHODS
  We performed a literature search using MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and scientific abstracts. Single-arm studies, nonrandomized and randomized controlled trials were included. We conducted random effects model meta-analyses to assess changes in the aforementioned outcomes.
  
  
  RESULTS
  We identified 16 single-arm studies, 2 crossover and 3 parallel-arm nonrandomized controlled trials and 5 crossover and 5 parallel-arm randomized controlled trials. In an analysis of 23 study arms or cohorts (n = 2221), ultrapure dialysate resulted in a significant decrease in C-reactive protein (-3.2 mg/L; 95% CI -4.6, -1.8; P < 0.001). Other markers of inflammation and oxidative stress displayed similar significant improvements. Ultrapure dialysate also resulted in a significant increase in serum albumin (0.11 g/dL; 95% CI 0.02, 0.19; P = 0.011) and hemoglobin (0.40 g/dL; 95% CI 0.06, 0.75; P = 0.022), and a decrease in the weekly erythropoietin dose (-273 units; 95% CI -420, -126; P < 0.001). The results remained significant in analyses restricted to controlled trials.
  
  
  CONCLUSIONS
  Use of ultrapure dialysate in hemodialysis patients results in a decrease in markers of inflammation and oxidative stress, an increase in serum albumin and hemoglobin and a decrease in erythropoietin requirement. Although improvement in these surrogate endpoints might confer a cardiovascular benefit, a large trial with hard clinical endpoints is required.
authors.affiliation: Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA.
authors.forename: Paweena
authors.initials: P
authors.lastname: Susantitaphong
authors.forename: Cristian
authors.initials: C
authors.lastname: Riella
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D000368:Aged; D000740:Anemia / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D015314:Dialysis Solutions / Q000494:pharmacology* / Q000592:standards; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects* / Q000502:physiology; D018384:Oxidative Stress / Q000187:drug effects* / Q000502:physiology; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000378:metabolism / Q000628:therapy
chemical_list: D015415:Biomarkers; D015314:Dialysis Solutions; D006454:Hemoglobins; D002097:C-Reactive Protein