Ultrapure dialysate improves iron utilization and erythropoietin response in chronic hemodialysis patients - A prospective cross-over study

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 (rHuE-PO) 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. Conclusion: 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.