Schiffl H, Lang S M, Stratakis D, Fischer R
Department of Nephrology, Medizinische Klinik and Medizinische Poliklinik Innenstadt, Universität München, Ziemssenstr. 1, D-80336 Münich, Germany.
Nephrol Dial Transplant. 2001 Sep;16(9):1863-9. doi: 10.1093/ndt/16.9.1863.
Malnutrition and chronic systemic inflammatory response syndrome not only coexist in uraemia, but may also have a bi-directional cause-and-effect relationship. To evaluate the role of dialysate-related cytokine induction in inflammatory response and nutritional status, we conducted a prospective comparison of two dialysis fluids differing in their microbiological quality.
Forty-eight early haemodialysis patients were assigned to either treatment with conventional (potentially microbiologically contaminated) or on-line produced ultrapure dialysis fluid. Study parameters were bacterial growth, markers of systemic inflammation (C-reactive protein (CRP) and interleukin 6), and parameters of nutritional status (estimated dry weight, upper mid-arm muscle circumference, serum albumin concentration, insulin-like growth factor 1, leptin, and protein catabolic rate). Patients were followed for 12 months.
There were no statistically significant differences in demographic and treatment characteristics, degree of bacterial contamination of the dialysate, markers of systemic inflammation, or parameters of nutritional status among the two treatment groups at recruitment. Changing from conventional to ultrapure dialysis fluid reduced significantly the levels of IL-6 (19+/-3 pg/ml to 13+/-3 pg/ml) and CRP (1.0+/- 0.4 mg/dl to 0.5+/-0.2 mg/dl), and resulted in significant increases in estimated dry body weight, mid-arm muscle circumference, serum albumin concentration, levels of the humoral factors, and in protein catabolic rate after 12 months. Continuous use of conventional dialysis fluid (median 40-60 c.f.u./ml) was not associated with significant alterations in markers of inflammation (IL-6 21+/-4 pg/ml vs 24+/-6 pg/ml, CRP 0.9+/-0.3 mg/dl vs 1.1+/-0.4 mg/dl) or of nutritional status at any time of the study. All differences in systemic inflammation and nutritional parameters observed during the study period (from recruitment to month 12) were significant between the two patient groups.
Cytokine induction by microbiologically contaminated dialysis fluid has a negative impact on nutritional parameters of early haemodialysis patients. The microbiological quality of the dialysis fluid represents an independent determinant of the nutritional status in addition to known factors, such as dose of dialysis and biocompatibility of the dialyser membrane. Ultrapure dialysis fluid adds to the cost of the dialytic treatment, but may improve the nutritional status in long-term haemodialysis patients.
营养不良和慢性全身炎症反应综合征不仅在尿毒症中共存，而且可能存在双向因果关系。为了评估透析液相关细胞因子诱导在炎症反应和营养状况中的作用，我们对两种微生物质量不同的透析液进行了前瞻性比较。
48例早期血液透析患者被分配接受常规（可能存在微生物污染）或在线生产的超纯透析液治疗。研究参数包括细菌生长、全身炎症标志物（C反应蛋白（CRP）和白细胞介素6）以及营养状况参数（估计干体重、上臂中部肌肉周长、血清白蛋白浓度、胰岛素样生长因子1、瘦素和蛋白质分解代谢率）。对患者进行了12个月的随访。
在招募时，两组患者的人口统计学和治疗特征、透析液细菌污染程度、全身炎症标志物或营养状况参数之间无统计学显著差异。从常规透析液改为超纯透析液可显著降低IL-6水平（从19±3 pg/ml降至13±3 pg/ml）和CRP水平（从1.0±0.4 mg/dl降至0.5±0.2 mg/dl），并导致12个月后估计干体重、上臂肌肉周长、血清白蛋白浓度、体液因子水平和蛋白质分解代谢率显著增加。持续使用常规透析液（中位数为40 - 60 c.f.u./ml）在研究的任何时间都与炎症标志物（IL-6 21±4 pg/ml对24±6 pg/ml，CRP 0.9±0.3 mg/dl对1.1±0.4 mg/dl）或营养状况的显著变化无关。在研究期间（从招募到第12个月）观察到的两组患者在全身炎症和营养参数方面的所有差异均具有统计学显著性。
微生物污染的透析液诱导细胞因子对早期血液透析患者的营养参数有负面影响。除了已知因素，如透析剂量和透析器膜的生物相容性外，透析液的微生物质量是营养状况的一个独立决定因素。超纯透析液增加了透析治疗的成本，但可能改善长期血液透析患者的营养状况。
