Impact of Dialysis Fluid Delivery System on Anemia in Hemodialysis Patients

Abstract

Background Patients on standard dialysis, in particular those on high-flux and high-efficiency dialysis, are exposed to hundreds of liters of dialysis-water per week. The quality of dialysis-water is a factor responsible for inflammation which is a potent trigger of atherosclerosis and a pathogenic factor in anemia, increasing mortality and morbidity in these patients. Current systems for water treatment do not completely eliminate bacteria and endotoxins. Our study tests if improved dialysiswater purity by using Central dialysis Fluid Delivery System (CDDS) can reduce inflammation and ameliorate hemoglobin levels. Aim of the Work The aim of this work is to compare between the effect of using Central Dialysis Fluid Delivery System (CDDS) and Single Dialysis Fluid Delivery System (SDDS) on Anemia in prevalent Hemodialysis Patients Patients and Methods This prospective observational cohort study was conducted between May 2019 and July 2019 and was conducted on 100 prevalent Hemodialysis Patient divided into 2 groups, each group included 50 patients, one group receiving Hemodialysis treatment using the central dialysis fluid delivery system (CDDS), while the other group receiving Hemodialysis treatment using the single-patient dialysis fluid delivery system (SPPDS). Results Endotoxin level in the dialysate fluid was found to be markedly lower in the CDDS group (0.05 EU/ml) compared to the SPDDS group (0.11 EU/ml). Baseline CRP level didn’t differ significantly between both groups (P-value: 0.88), however throughout the follow up period patients who were on dialysis using the CDDS showed a sustained significant decrease in CRP level compared to those using the SPDDS (P-value: <0.001 for the 3m follow up period), denoting improvement of their chronic inflammatory status. Baseline hemoglobin level didn’t differ significantly between both groups (P-value: 0.52), however throughout the follow up period patients who received dialysis using CDDS showed a sustained significant increase in their hemoglobin level, while those receiving dialysis using SPDDS showed no significant change in their hemoglobin level, also hemoglobin level in the CDDS Group was higher than in the SPDDS group at 1st, 2nd and 3rd months. (P-value: 0.008, <0.001 and <0.001 for the follow up month 1, 2 and 3 respectively). Using URR as an indicator for efficiency of the HD session, there was no statistically significant difference between both groups among three months of follow-up. Conclusion Ultrapure dialysis fluid (UPD) produced by the Central dialysis