Effect of ultrapure dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters: a meta-analysis

Susantitaphong, Paweena; Riella, Cristian; Jaber, Bertrand L.

doi:10.1093/ndt/gfs514

Cited by 89 publications

(73 citation statements)

References 56 publications

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“…Recent meta-analysis demonstrated that the use of ultrapure dialysate in HD 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 [92]. Short daily dialysis, as compared with conventional HD, lowered CRP and improved erythropoietin sensitivity [93].…”

Section: Correction Of Inflammation In Ckdmentioning

confidence: 99%

Update on Inflammation in Chronic Kidney Disease

2015

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Background: Despite recent advances in chronic kidney disease (CKD) and end-stage renal disease (ESRD) management, morbidity and mortality in this population remain exceptionally high. Persistent, low-grade inflammation has been recognized as an important component of CKD, playing a unique role in its pathophysiology and being accountable in part for cardiovascular and all-cause mortality, as well as contributing to the development of protein-energy wasting. Summary: The variety of factors contribute to chronic inflammatory status in CKD, including increased production and decreased clearance of pro-inflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, including those related to dialysis access, altered metabolism of adipose tissue, and intestinal dysbiosis. Inflammation directly correlates with the glomerular filtration rate (GFR) in CKD and culminates in dialysis patients, where extracorporeal factors, such as impurities in dialysis water, microbiological quality of the dialysate, and bioincompatible factors in the dialysis circuit play an additional role. Genetic and epigenetic influences contributing to inflammatory activation in CKD are currently being intensively investigated. A number of interventions have been proposed to target inflammation in CKD, including lifestyle modifications, pharmacological agents, and optimization of dialysis. Importantly, some of these therapies have been recently tested in randomized controlled trials. Key Messages: Chronic inflammation should be regarded as a common comorbid condition in CKD and especially in dialysis patients. A number of interventions have been proven to be safe and effective in well-designed clinical studies. This includes such inexpensive approaches as modification of physical activity and dietary supplementation. Further investigations are needed to evaluate the effects of these interventions on hard outcomes, as well as to better understand the role of inflammation in selected CKD populations (e.g., in children).

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Section: Correction Of Inflammation In Ckdmentioning

confidence: 99%

Update on Inflammation in Chronic Kidney Disease

2015

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“…These include better hemodynamic stability [14]; easier control of extracellular fluid overload; higher removal of several mediators involved in inflammation regulation, cytokine production and accelerated atherosclerosis; better control of hyperphosphataemia; and reduction of erythropoiesis-stimulating agents resistance index [15]. Recently, reduction in cardiovascular mortality has also been confirmed by a large meta-analysis of RCTs comparing convective treatments to low-flux haemodialysis [16]. The outcome was associated with a significant increase in the removal of middle-sized and protein-bound solutes as well as a decrease in inflammation markers.…”

Section: Discussionmentioning

confidence: 99%

Improved Survival of Incident Patients with High-Volume Haemodiafiltration: A Propensity-Matched Cohort Study with Inverse Probability of Censoring Weighting

Canaud

Bayh

Marcelli

et al. 2015

Nephron

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Background: Haemodiafiltration (HDF) is the preferred dialysis modality in many countries. The aim of the study was to compare the survival of incident patients on high-volume HDF (HV-HDF) with high-flux haemodialysis (HD) in a large-scale European dialysis population. Methods: The study population was extracted from 47,979 patients in 369 NephroCare centres throughout 12 countries. Baseline was six months after dialysis initiation; maximum follow-up was 5 years. Patients were either on HV-HDF (defined as with ≥21 litres substitution fluid volume per session) or on HD if on that treatment for ≥75% of the 3 months before baseline. The main predictor was treatment modality. Other parameters included country, age, gender, BMI, haemoglobin, albumin and Charlson comorbidity index. Propensity score matching and Inverse Probability of Censoring Weighting (IPCW) were applied to reduce bias by indication and consider modality crossover, respectively. Results: After propensity score matching, 1,590 incident patients remained. Kaplan-Meier and proportional Cox regression analyses revealed no significant survival advantage of HV-HDF. Results were biased by modality crossover: during the 5-year study period, 7% of HV-HDF patients switched to HD, and 55% of HD patients switched to HV-HDF. IPCW uncovered a statistically significant survival advantage of HV-HDF (OR 0.501; CI 0.366-0.684; p < 0.001). A higher benefit of HV-HDF for some subgroups was revealed, for example, non-diabetics, patients 65-74 years, patients with obesity or high blood pressure. Conclusions: This large-scale study supports the generalizability of previous RCT findings regarding the survival benefit of HV-HDF. Sub-group analysis showed that some sub-cohorts appear to benefit more from HV-HDF than others.

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“…In this study of conventional HD the microbiological and chemical analyses were not consistently within accepted limits for ultrapure dialysate but of note a viable bacterial count, >0.1 CFU/ml, was observed on only six occasions cumulatively in all centres for the 3 months preceding water treatment change. A meta-analysis of 21 trials examining the effects of ultrapure dialysate demonstrated significant reduction in markers of inflammation and oxidative stress with accompanying lowered requirement for ESAs and significantly improved serum albumin and Hb levels [31]. Conversion from conventional to ultrapure dialysate has been demonstrated to result in reduced inflammatory markers, ESA dose and improved iron utilisation [32].…”

Section: Discussionmentioning

confidence: 99%

Pre-Emptive Replacement of Water Treatment Components Improves Responsiveness to Erythropoiesis-Stimulating Agents in Maintenance Haemodialysis Patients: A Quality Improvement Report

Singh¹,

Loucaidou²,

Power³

et al. 2013

Blood Purif

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Hypo-responsiveness to erythropoiesis-stimulating agents (ESAs) has been associated with increased mortality. We examined the effect of water treatment component replacement on declining ESA responsiveness in the absence of chemical or microbiological standards failure. Pre-emptive renewal of the water treatment system supplying 802 standard-flux haemodialysis patients resulted in a significant rise in haemoglobin from (mean ± SD) 12.1 ± 1.2 to 12.3 ± 1.0 g/dl (p < 0.0001), accompanied by a significant decrease in prescribed dose of darbepoetin alfa from 47.9 ± 27.3 to 44.7 ± 27.6 μg/week (p < 0.0001). ESA responsiveness improved significantly from 0.060 ± 0.041 to 0.055 ± 0.040 μg/kg/g·dl^-1 (p < 0.0001) and the number of patients no longer requiring ESA therapy increased threefold. These benefits were derived in the absence of haemolysis or significant changes in water quality. Renewal of water system components should be conducted even in the absence of proven microbiological and chemical failure.

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Effect of ultrapure dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters: a meta-analysis

Cited by 89 publications

References 56 publications

Update on Inflammation in Chronic Kidney Disease

Update on Inflammation in Chronic Kidney Disease

Improved Survival of Incident Patients with High-Volume Haemodiafiltration: A Propensity-Matched Cohort Study with Inverse Probability of Censoring Weighting

Pre-Emptive Replacement of Water Treatment Components Improves Responsiveness to Erythropoiesis-Stimulating Agents in Maintenance Haemodialysis Patients: A Quality Improvement Report

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