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Ultrapure dialysate decreases plasma pentosidine, a marker of “carbonyl stress”

Ultrapure dialysate decreases plasma pentosidine, a marker of “carbonyl stress”,10.1053/j.ajkd.2004.02.015,American Journal of Kidney Diseases,Yuko Iz

Ultrapure dialysate decreases plasma pentosidine, a marker of “carbonyl stress”   (Citations: 23)
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Background: Advanced glycation end products (AGEs) and their reactive carbonyl precursors accumulate in renal failure (“carbonyl stress”). Carbonyl stress derives from a broad derangement in the nonenzymatic biochemistry of both carbohydrates and lipids. We tested the influence of dialysate quality on plasma level of pentosidine, an AGE moiety taken as a surrogate marker of carbonyl stress, in hemodialysis patients. Methods: Plasma pentosidine is measured by means of high-performance liquid chromatography in patients hemodialyzed successively with a conventional and an ultrapure endotoxin-free dialysate. Results: Dialysate endotoxin level decreased from 0.040 ± 0.017 EU/mL before the switch to the new water supply system to less than the detection limit (<0.001 EU/mL) after the switch. Plasma pentosidine levels decreased from 1.55 ± 0.61 nmol/mL before the switch to 1.38 ± 0.52 nmol/mL (P < 0.0001) and 1.31 ± 0.50 nmol/mL (P < 0.0001) 3 and 6 months after the switch to an ultrapure dialysate, respectively. Decreases in plasma pentosidine levels were similar regardless of dialyzer membrane type; ie, high-flux polysulfone, high-flux polymethylmethacrylate, and low-flux cellulose acetate membranes. Unexpectedly, plasma triglyceride levels decreased from 150 ± 116 mg/dL (1.69 ± 1.31 mmol/L) before the switch to 124 ± 79 mg/dL (1.40 ± 0.89 mmol/L; P < 0.01) and 119 ± 75 mg/dL (1.34 ± 0.85 mmol/L; P < 0.01) 3 and 6 months after the switch despite unchanged total cholesterol levels, respectively. Changes in pentosidine levels were unrelated to those in triglycerides, and both were unrelated to C-reactive protein levels, which remained stable throughout the study. Conclusion: Ultrapure dialysate reduces plasma pentosidine levels and improves plasma triglyceride levels in hemodialysis patients through still undefined mechanisms.
Journal: American Journal of Kidney Diseases - AMER J KIDNEY DIS , vol. 43, no. 6, pp. 1024-1029, 2004
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    • ... and in the reduction of pentosidine, a marker of carbonyl stress [...

    Hirokazu Hondaet al. Ultrapure Dialysate Influences Serum Myeloperoxidase Levels and Lipid ...

    • ...4. Test for ComplianceEndotoxin:Limulus amoebocyte lysate (LAL) assay (gel-clot assay, spectrophotometric kinetic assay).– Bacteria: Culture media R2A (Reasoner’s Agar No. 2), TGEA (tryptone glucose extract agar) or equivalent.Cultivation condition: R2A and TGEA: 17–23°C, 7 days.5. Sampling Sites– Dialysis water: Outlet of RO equipment– Dialysis fluid: Inlet line of dialyzerNote: Push & pull hemodiafiltration (HDF) systems should be tested on the outlet line of dialyzer.Online-prepared substitution fluid: extraction site of substitution fluid.6. Sampling Day: Before Start of Dialysis and After the Maximal Interval of Dialysis (Commonly Monday)7. Standard of Endotoxin Retentive Filter (ETRF)– ETRF should meet the requirement of Japan Medical Devices Manufacturers Association.– The user should follow the user’s manual of each ETRF.– Exchange time should meet the manufacturer’s standard for each ETRF.– If the manufacturer’s standard does not indicate the exchange time, each facility should validate the performance of ETRF. The validated data should be reported to and confirmed by the dialysis equipment safety management committee.8. Safety Assurance ProgramsDialysis fluids and apparatus must be managed according to an appropriate manual. Therefore, the persons responsible for the safety management of medical equipment must validate the dialysis apparatus at their facilities. They should then take the following measures:(1) Establishment of a curriculum for education and training of dialysis operators.(2) Preparation and assurance of the availability of a manual for dialysis fluid management.(3) Management records and measurement records must be prepared and preserved similar to clinical records. The related documents must be preserved for 3 years from the date of preparation.(4) For the management of the dialysis apparatus and water quality of dialysis fluids, a dialysis equipment safety management committee must be established under the person responsible for the safety management of medical equipment, to perform the following activities:– A management plan for dialysis equipment and water treatment apparatus must be prepared. Appropriate maintenance work must be performed. Reports must be preserved.– Seminars for staff members to promote the appropriate use of dialysis equipment must be arranged.– Related medical information must be collected by a single entity. Delivery of the information to staff members must be assured. Accident-related information must be reported immediately to the committee.(5) Online-prepared substitution fluids can be used only after validation by the dialysis equipment safety management committee. The committee shall provide written approval prior to use.DiscussionThere have been various reports and reviews regarding the necessity of dialysis fluid purification. In addition, the adverse effects of microbiological contamination and dissociation between the bacterial count and endotoxin level have become widely recognized. Further, very low levels of contamination have been reported to impair biocompatibility [,,,,...

    Hideki Kawanishiet al. The New Standard of Fluids for Hemodialysis in Japan

    • ...Endotoxin contents of dialysis fluids were determined by means of endotoxin-specific limulus reagent (Endospecy [8]; Seikagaku Corp., Tokyo, Japan)...

    Nobuyasu Yamaguchiet al. Rapid monitoring of bacteria in dialysis fluids by fluorescent vital s...

    • ...been associated with a decrease in the plasma concentrations of markers of inflammation [7–10], and oxidant stress [10,11], improved nutritional status as measured by serum albumin, clinically estimated dry body weight, mid-arm muscle circumference and protein catabolic rate [7], and an increased responsiveness to erythropoietin as measured by an increase in haemoglobin with similar or decreased doses of erythropoietin [8,12]...
    • ...Other investigators also have reported no change in serologic markers of inflammation or a reversion to baseline values over time [11,18,20]...
    • ...This finding is in contrast to the observations of Furuya et al. [10] and Izuhara et al. [11] who reported a significant decrease in the plasma concentration of pentosidine, a marker of carbonyl stress, in patients treated with ultrapure dialysate...

    Rosemary Ousephet al. Use of ultrafiltered dialysate is associated with improvements in haem...

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