Several treatment related stimuli, including bacterial endotoxins derived from dialysis fluid8,9 can increase oxidative stress — a situation in which the normal balance between production of reactive oxygen species (ROS) and antioxidant activity is tilted in favour of ROS. As oxidative stress is associated with the progression of malnutrition, anemia and inflammatory diseases such as atherosclerosis, the usage of ultrapure dialysis fluid to reduce dialysis induced oxidative mechanisms appears desirable8,9.
Advanced Glycation End Products (AGE)
The importance of ultrapure dialysis fluid in routine hemodialysis treatments is emphasized by the finding that endotoxins act in synergy with advanced glycation end products (AGE), which enhance inflammation and oxidative stress10. The use of ultrapure dialysis fluid has further been shown to reduce the plasma levels of the AGE compound pentosidine11.
Ultrapure dialysis fluid has been shown to improve iron utilization and the response to erythropoietin, meaning it could be beneficial in anemia treatment by allowing for a reduced erythropoietin dosage while maintaining optimal hemoglobin levels12,13.