Effect of Central Dialysis Fluid Delivery System (CDDS) using high flux dialyzer versus Regular Water Treatment Stations on Endotoxemia and Inflammatory Markers among Prevalent Patients on Regular Hemodialysis

Abstract

Abstract Background and Objectives Translocated endotoxins derived either from intestinal bacteria or backfiltration, have a wide range of adverse effects on patients. Most end stage renal disease (ESRD) patients have systemic inflammation which increases the risk of morbidity and mortality. The central dialysis fluid delivery system (CDDS) has been used exclusively in Japan since 1960s, and now is being used in Ain Shams University. Our aim of the study is to evaluate the effect of (CDDS) versus single patient dialysis fluid delivery system (SPDDS) on endotoxemia and inflammatory markers among prevalent patients on regular hemodialysis (HD). Methods Eighty Patients were randomly selected from HD units, then divided into two groups, (group I) doing HD using CDDS water purification system at El Demerdash Hospital, (group II) using regular water purification system at Ain Shams University Specialized Hospital. Pre- dialysis and post-dialysis serum samples were obtained to measure endotoxin levels of both groups, as well as postdialysis serum samples were obtained to measure interleukin 6 (IL6) level and highly sensitive Creactive protein (Hs CRP). Results Circulating endotoxemia was most notable in group II, The mean predialysis endotoxin level in group I was 0.07 ± 0.05 Eu/mL, while in group II was 0.20 ± 0.07 Eu/mL and mean of post-dialysis endotoxin level in group I was 0.04 ± 0.02 Eu/mL, while in group II was 0.15 ± 0.03 Eu/mL. IL6 as well as Hs CRP levels were higher in group II in comparison to group I. Conclusion Our data showed significant reduction in circulating endotoxins in CDDS group.