Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA.
Nephrol Dial Transplant. 2013 Feb;28(2):438-46. doi: 10.1093/ndt/gfs514. Epub 2013 Jan 4.
Markers of inflammation are linked to malnutrition and confer an increased mortality risk in hemodialysis patients. Ultrapure dialysate might have a beneficial effect on markers of inflammation. We conducted a meta-analysis that examined the effect of ultrapure versus standard dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters.
We performed a literature search using MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and scientific abstracts. Single-arm studies, nonrandomized and randomized controlled trials were included. We conducted random effects model meta-analyses to assess changes in the aforementioned outcomes.
We identified 16 single-arm studies, 2 crossover and 3 parallel-arm nonrandomized controlled trials and 5 crossover and 5 parallel-arm randomized controlled trials. In an analysis of 23 study arms or cohorts (n = 2221), ultrapure dialysate resulted in a significant decrease in C-reactive protein (-3.2 mg/L; 95% CI -4.6, -1.8; P < 0.001). Other markers of inflammation and oxidative stress displayed similar significant improvements. Ultrapure dialysate also resulted in a significant increase in serum albumin (0.11 g/dL; 95% CI 0.02, 0.19; P = 0.011) and hemoglobin (0.40 g/dL; 95% CI 0.06, 0.75; P = 0.022), and a decrease in the weekly erythropoietin dose (-273 units; 95% CI -420, -126; P < 0.001). The results remained significant in analyses restricted to controlled trials.
Use of ultrapure dialysate in hemodialysis 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. Although improvement in these surrogate endpoints might confer a cardiovascular benefit, a large trial with hard clinical endpoints is required.
炎症标志物与血液透析患者的营养不良有关，并增加死亡率风险。超纯透析液可能对炎症标志物有有益的影响。我们进行了一项荟萃分析，研究了超纯与标准透析液对炎症标志物、氧化应激、营养和贫血参数的影响。
我们使用 MEDLINE、Scopus、Cochrane 对照试验中心注册库、ClinicalTrials.gov 和科学摘要进行了文献检索。纳入了单臂研究、非随机和随机对照试验。我们进行了随机效应模型荟萃分析，以评估上述结局的变化。
我们确定了 16 项单臂研究、2 项交叉和 3 项平行臂非随机对照试验以及 5 项交叉和 5 项平行臂随机对照试验。在对 23 个研究臂或队列（n=2221）的分析中，超纯透析液可显著降低 C 反应蛋白（-3.2mg/L；95%CI-4.6，-1.8；P<0.001）。其他炎症和氧化应激标志物也显示出类似的显著改善。超纯透析液还可显著增加血清白蛋白（0.11g/dL；95%CI0.02，0.19；P=0.011）和血红蛋白（0.40g/dL；95%CI0.06，0.75；P=0.022），并减少每周促红细胞生成素剂量（-273 单位；95%CI-420，-126；P<0.001）。在限制于对照试验的分析中，结果仍然显著。
在血液透析患者中使用超纯透析液可降低炎症和氧化应激标志物，增加血清白蛋白和血红蛋白，并减少促红细胞生成素的需求。尽管这些替代终点的改善可能带来心血管益处，但仍需要进行具有严格临床终点的大型试验。
