Abstract:

Objective    To explore the effect of ultrapure dialysate on erythropoietin (EPO) resistance in patients on maintenance hemodialysis. Methods    70 patients taking regular hemodialysis were randomly divided into two groups： the conventional dialysate group（n=35） and the ultrapure dialysate group（n=35）. All the patients had been on hemodialysis for more than 3 months and on the EPO treatment for more than 3 months. EPO dosage was titrated to maintain a target hemoglobin（Hb）level between 110g/L and 120g/L. EPO resistance index (ERI) was calculated as weekly EPO dose/kg weight/g Hb. Laboratory tests including the general examination of blood, biochemistry test of blood, serum ferritin, hypersensitive C reactive protein (hs-CRP) and intact parathyroid hormone (iPTH) were detected in each patient. The relationship between ERI and laboratory factors mentioned above was analyzed. And after 12-month treatment, differences of hs-CRP and ERI were analyzed betweenthe two groups. Results    Correlation analysis showed that ERI had a statistically significant correlation with CRP (r=0.432，P<0.01), serum albumin (r =-0.359，P<0.05), iPTH (r=0.316，P<0.05) and nPCR (r =-0.307，P<0.05). hs-CRP was the most important independent predictor of ERI (R2=0.699, P<0.001) by multiple linear stepwise regression analysis. After 12-month treatment, there were marked differences in hs-CRP and ERI between the conventional dialysate group and the ultrapure dialysate group (5.12±2.74 vs 3.77±2.19, P<0.05 and 1.64±0.71 vs 1.10±0.53, P<0.01, respectively). Conclusions    CRP, serum albumin, iPTH and nPCR are factors related to ERI . hs-CRP is the most important independent predictor of ERI. Use of ultrapure dialysate should be beneficial to the inflammation status and ERI in long-term hemodialysis patients.

Key words:  Ultrapure dialysate; Hemodialysis; Erythropoietin; Erythropoietin resistance