Effects of ultrapure dialysis fluid on nutritional status and inflammatory parameters
Effects of ultrapure dialysis fluid on nutritional status and inflammatory parameters
复制标题
DOI：
10.1093/ndt/16.9.1863
复制
发表时间：
2001-09-01
影响因子：
6.1
通讯作者：
Fischer, R
中科院分区：
文献类型：
--
作者：
Schiffl, H;Lang, SM;Fischer, R
背景。营养不良与慢性全身性炎症反应综合征不仅在尿毒症中共存，而且可能存在双向的因果关系。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名早期血液透析患者被分配到常规（可能被微生物污染）或在线生产的超纯透析液治疗组。研究参数包括细菌生长、全身性炎症标志物（c反应蛋白（CRP）和白细胞介素6）以及营养状况参数（估计干重、上臂中肌围、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）。随访12个月。招募时，两个治疗组在人口统计学和治疗特征、透析液细菌污染程度、全身性炎症标志物或营养状况参数方面没有统计学上的显著差异。从常规透析液到超纯透析液的改变显著降低了IL-6 （19 +/-3 pg/ml至13 +/-3 pg/ml）和CRP （1.0 +/-0.4 mg/dl至0.5 +/-0.2 mg/dl）的水平，并导致12个月后估计干体重、中臂肌围、血清白蛋白浓度、体液因子水平和蛋白质分解代谢率的显著增加。持续使用常规透析液（中位数40-60 c.f.u./ml）与炎症标志物（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）或营养状况在研究任何时间的显著改变无关。在研究期间（从招募到第12个月），两组患者之间观察到的全身炎症和营养参数的所有差异都是显著的。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。除了透析剂量和透析膜的生物相容性等已知因素外，透析液的微生物质量是营养状况的独立决定因素。超纯透析液增加了透析治疗的成本，但可以改善长期血液透析患者的营养状况。
Background. 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.Methods. 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.Results. 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.Conclusions. 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.