[Effects of ultrapure water on the levels of oxidative stress and inflammation parameters in maintenance hemodialysis patients].

OBJECTIVE: To evaluate the effects of ultrapure water on the levels of oxidative stress and inflammation parameters in maintenance hemodialysis patients. METHODS: Thirty-six stable maintenance hemodialysis patients were involved in this study, who were free of acute infection, vasculitis or disease activity and on hemodialysis therapy for at least 3 months before using ultrapure water. The parameters including serum advanced oxidation protein products (AOPP), malondialdehyde (MDA), glutathione peroxidase (GSH-Px), myeloperoxidase (MPO), albumin (Alb), C-reactive protein (CRP), neopterin , tumor necrosis factor (TNF)-alpha, and interleukin (IL)-6 were measured before and 6, 12 months after use of ultrapure water, respectively. RESULTS: After modification of the water management system, the microbial counts and endotoxin concentration decreased significantly (P<0.01). During the study period, the levels of the measured parameters gradually improved, showing significant difference between the time points of measurement (P<0.05). Use of ultrapure water for 6 months significantly improved serum AOPP, MDA, GSH-Px, MPO, Alb, CRP, neopterin, and TNF-alpha levels (P<0.05), and the level of IL-6 was further reduced after 12 months (P<0.05). Serum MPO activity was closely correlated with AOPP (r=0.335, P<0.05) and CRP (r=0.369 or 0.347, P<0.05) before or after use of ultrapure water. CONCLUSIONS: Ultrapure water can improve the status of oxidative stress and inflammation in maintenance hemodialysis patients. Serum MPO activity may help estimate the levels of oxidative stress and inflammation.

[The protective effects to the function of kidney and long by clearing of cytokines in patients with open-heart surgery].

OBJECTIVE: To observe the effect of cytokines absorption on renal and respiratory function in patients with open-heart surgery. METHODS: 30 patients undergoing valve replacement with cardiopulmonary bypass (CPB) were randomly divided into two groups. A sulfonated polyacrylonitrile hemofilter (AN69) that has been used to absorb cytokines was connected into the efferent limb of CPB in Group A (n = 15), and a cellulose triacetate hemofilter (CT 190G) instead of AN69 was used as controls (Group B, n = 15). The levels of plasma pro-inflammatory (TNF-alpha, IL-6, IL-8) anti-inflammatory cytokines (IL-10, IL-1ra), C-reactive protein (CRP) levels, and post-operation renal and respiratory function were compared between the two groups. Blood samples were analysed for TNF-alpha and IL-6 and IL-8 and C-reactive protein (CRP). The changes in renal, respiratory function were also observed. RESULTS: (1) At the end of CPB, TNF-alpha 10 ng/L +/- 3 ng/L and IL-6 115 ng/L +/- 22 ng/L levels in Group A were significantly lower than that in Group B 13 ng/L +/- 3 ng/L, 134 ng/L +/- 29 ng/L) respectively (P < 0.05 in all). There is no statistical differences in plasma IL-10 and IL-1ra levels between the two groups. (2) After 24 hours of CPB, the magnitude of increased body temperature, heart rate, white blood cell and plasma CRP in Group A [1.6 degrees C +/- 0.2 degrees C, 15/min +/- 4/min, (17 +/- 3) x 10(9)/L, 56 mg/L +/- 13 mg/L], were significantly lower than that in Group B [2.1 degrees C +/- 0.2 degrees C, 23/min +/- 6/min, (22 +/- 3) x 10(9)/L, 69 mg/L +/- 15 mg/L] respectively (P < 0.05 in all). (3) After 24 hours of CPB, the levels of 24h urinary protein excretion and urinary N-acetyl-beta-D-glucosaminidase (NAG) were significantly lower in Group A when compared to that in Controls (0.20 g/d +/- 0.08 g/d vs 0.30 g/d +/- 0.14 g/d, 28 U/L +/- 11 U/L vs 38 U/L +/- 13 U/L respectively), P < 0.05 in all. The level of creatinine clearance (Ccr) in Group A (68 +/- 7) ml.min(-1).1.73 m(-2) was significantly elevated than that in Group B (57 +/- 11) ml.min(-1).1.73 m(-2) (P < 0.05). (4) One hour after the end of CPB, the magnitude of increased plateau airway pressure (P(Plateau)) and peak airway pressure (P(Peak)) in Group A were significantly lower than that in Controls (P < 0.01 in all). The duration that need mechanical ventilation after operation in Group A (4.9 h +/- 0.6 h) was much shorter than that in Group B (5.8 h +/- 0.8 h, P < 0.05). CONCLUSIONS: Lowering the plasma levels of cytokines by extracorporeal absorption may attenuate systemic inflammatory response and protect lung and kidney function in patients with open-heart surgery.

Effect of blood purification on plasma levels of intact parathyroid hormone in patients with chronic renal failure.

OBJECTIVE: To study the effects of hemoperfusion and/or hemodialysis on plasma levels of intact parathyroid hormone (iPTH) in patients with chronic renal failure (CRF). METHODS: A total of 40 uremic patients were randomly divided into two groups to receive hemoperfusion in combination with hemodialysis (HP+HD) or exclusive hemodialysis (HD), respectively. Plasma iPTH concentration was measured by means of radio immunoassay. RESULTS: After the blood purification procedures, the patients' plasma iPTH levels were reduced from 1,508.70+/-1,268.89 to 1,049.04+/-992.91 microg/ml (P<0.001) in HD group and from 1,600.70+/-1,151.15 to 745.47+/-785.02 microg/ml (P<0.001) in HP+HD group. CONCLUSION: Blood purification with hemoperfusion plus hemodialysis may decrease plasma iPTH levels more efficiently than hemodialysis performed alone.