Effects of Dialysis Purity on Uremic Dyslipidemia
Article first published online: 11 AUG 2009
© 2009 The Authors. Journal compilation © 2009 International Society for Apheresis
Therapeutic Apheresis and Dialysis
Volume 14, Issue 1, pages 5–11, February 2010
How to Cite
Schiffl, H. and Lang, S. M. (2010), Effects of Dialysis Purity on Uremic Dyslipidemia. Therapeutic Apheresis and Dialysis, 14: 5–11. doi: 10.1111/j.1744-9987.2009.00713.x
- Issue published online: 12 FEB 2010
- Article first published online: 11 AUG 2009
- Received March 2009; revised May 2009.
- Maintenance dialysis;
- Ultrapure dialysis fluid;
- Uremic dyslipidemia
Dyslipidemia, a prominent feature of end-stage renal disease, is considered a risk factor for premature atherosclerosis in hemodialysis (HD) patients. Dyslipidemia is related to loss of kidney function as well as use of low-flux cellulosic dialyzer membranes, but the effects of dialysate purity are unknown. Forty-eight incident HD patients started high-flux polysulfone maintenance HD, either with conventional (potentially contaminated) or with on-line produced ultrapure dialysate. The quality of the dialysis fluid (CFU/mL, endotoxin concentration), markers of inflammation (C-reactive protein, Il-6), and parameters of the lipid profile and oxidative stress (oxidized low-density lipoprotein) were measured before initiation of HD, and after 6, 12 and 24 months on HD. Compared to baseline, treatment with conventional (mildly contaminated) dialysate significantly increased the uremic low-grade systemic inflammatory response syndrome (SIRS), augmented uremic dyslipidemia (triglycerides by +21%, and high-density lipoprotein (HDL) cholesterol by −10%) and enhanced oxidative stress. In contrast, the use of ultrapure dialysate significantly decreased uremia-associated SIRS, dyslipidemia (triglycerides −7% and HDL cholesterol +11%) and oxidative stress. Ultrapure dialysis fluid improves potential parameters of cardiovascular risk by decreasing inflammatory reactions, improving uremic dyslipidemia and lowering oxidative stress.