Abstract
The aim of this study was to evaluate the levels of malondialdehyde as an oxidative stress marker in the same hemodialysis patients after changing the quality of dialysate with ultrapure dialysis fluid. Methods. This prospective study concerns hemodialysis patients; all patients were in the first step treated with conventional dialysate, and in the second step (three months later) the same patients were treated with online produced ultrapure dialysis fluid. The malondialdehyde, C-reactive protein, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, fibrinogen, and albumin were quantified before the two steps. Results. Thirty-seven patients completed the study. Ultrapure dialysis fluid reduced but not significantly the malondialdehyde concentrations. Both dialysis fluids were associated with improvement in the malondialdehyde level before and after the hemodialysis session. In lipid parameters, there was a significant decrease with conventional dialysis fluid versus ultrapure dialysis fluid of triglycerides, total cholesterol, and high-density lipoprotein in patients' blood. Instead, the level of low-density lipoprotein, fibrinogen, albumin, and C-reactive protein does not change significantly. Conclusion. The lipid parameters were improved for triglycerides and total cholesterol. Malondialdehyde increases following the hemodialysis session, and the conventional dialysate increased malondialdehyde levels more than the ultrapure dialysis but the differences were not statistically significant.
Highlights
E chlorine compounds used to suppress bacterial growth in the potable water supply are removed when the water is treated for hemodialysis
We con rm that MDA increases in blood’s patient following HD session, and we found that the conventional dialysate increased MDA levels more than ultrapure dialysate but the differences were not statistically signi cant
It was shown that the MDA is a good marker for assessing oxidative stress generated by the water quality in HD because there is no in uence of other in ammatory parameters
Summary
E chlorine compounds used to suppress bacterial growth in the potable water supply are removed when the water is treated for hemodialysis. Even though conventional dialysate meets the required quality standards, it usually contains some low level of microbiological contamination, including fragments of endotoxin and peptidoglycans and bacterial fragments [1,2,3]. Ese contaminants, sometimes collectively referred to as “cytokine-inducing substances,” cross both low- ux and high- ux hemodialysis membranes [2, 4] and stimulate cytokine production by in ammatory cells [5]. General markers of in ammation such as serum C-reactive protein (CRP), ferritin, or brinogen are commonly used, but the oxidative stress referred to excessive production of reactive oxygen species (ROS) and inadequate antioxidant protection, is more sensitive, speci c, and precocious of in ammation state. ISRN Nephrology quanti cation of MDA in the CRF patients a er changing quality of dialysate with ultrapure dialysis uid
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