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Objective: To examine the changes of serum myeloper- oxidase (MPO), malondialdehyde (MDA) levels before and after the use of ultrapure-water in maintenance hemodialysis patients. To discuss whether the ultra-pure water dialysis could improve oxidative stress in hemodialysis patients.Method: 26 maintenance hemodialysis patients were selected, who were treated in the blood purification center of the Fourth hospital of Hebei medical university from October 2006 to October 2008 . There were 19 males and 6 females, averaging 58.68±17.4 years. The cause of chronic renal failure was chronic glomerulonephritis in 12, diabetes mellitus in 7, autosomal dominant polycystic kidney disease in 3, other causes in 4 patients. Dialysis frequency was 2-3 times per week,4-4.5 hours each time. All the patients used low molecular heparin anticoagulation (QiZheng), used bicarbonate dialysate, used internal arteriovenous fistula. The blood flow rate was 220-250ml/min and the dialysate flow rate was 500ml/min, Kt/V > 1.2. The dialysis machine was Fresenius 4008S. All the patients had dialyzed 12 months using standard water. All the patients were in a stable clinical condition. None of them had acute infection or active immunity dieases. All the patients didn’t receive transfusion,(including plasma and serum albumin), hormone, immunosuppressant or antioxidants (including vitamin C, vitamin E), were not given the intravenous infusion of iron, were without surgery and trauma. Other dialysis conditions, except water quality, were the same. 4 ml Pre- dialysis blood samples were collected respectively using standared water for 12 months, ultra-pure water for 6 months and 12 months. The serum was collected after centrifuge and kept in-80℃until the determination of the MDA, ALB concentration and MPO, SOD activity. The level of endotoxin and bacteria growth were measured in standard water and ultra-pure water. The level of endotoxin was determined by the Limulus amebocyte lysate (LAL) assay. The level of bacteria growth was determined by the pour-plate method. The consequence was in accordance with the criteria about standard water and ultra-pure water issued by AAMI in 2004. The concentration of MPO was determined by spectrophotometry , the concentration of MDA was determined by the thiobarbituric acid reaction method, the concentration of ALB was determined by the bromine cresol green reaction method and SOD activity was determined by the yellow purine xidase method. To compare the changes of serum MDA, ALB, MPO, SOD levels between the ues of standard water and ultrapure-water, both for 12 months, in maintenance hemodialysis patients. To observe the changes of serum MPO, MDA, ALB, and SOD levels after the use of ultrapure-water for 6 months and 12 months. All date were expressed as mean±standard deviation ( x±s), tested for normal distribution and with anova . Subsequently the pre-and post-values of the same variable were compared with Paired t tests. Otherwise, Wilcoxon Signed rank tests were used. To check up the repeated measuerment data with repeated mesuerment anova test. If Mauchly test P<0.05,correct the freedom with Greenhouse-Geisserεcorrection. The compare between before and after oneself with Bonferroni test. P<0.05 was statistically significant. Analysis was conducted with SAS statistical software ver 6.12 .Results:1 The levels of MPO, MDA, ALB and SOD of the 26 hemodialysis patients using standard water for 12 months were(405.30±191.66U/L,12.93±3.68nmol/ml,35.02±2.88g/L,106.27±12.82U/ml)respectively, the levels of MPO, MDA ,ALB and SOD using ultra-pure water for 12 months were (250.36±25.23U/L,10.90±1.97nmol/ml,37.39±2.75g/L,111.39±14.28U/ml) respectively. After the use of ultra-pure water dialysis, the levels of MPO and MDA decreased remarkably (P=0.0000,P= 0.003) respectively, the levels of ALB increased remarkably, P =0.011, the levels of SOD were unchanged, P=0.054.2 After the use of ultra-pure water for 6 months, the levels of serum MPO, MDA, ALB and SOD were (258.41±97.20 U/L, 12.66±2.97nmol/ml, 35.16±2.88g/L, 111.77±10.33U/ml) respe- ctively. After the use of ultra-pure water for 12 months, the levels of serum MPO, MDA, ALB and SOD were (250.36±25.23 U/L, 10.90±1.97 nmol/ml, 37.39±275 g/L, 111.39±14.28 U/ml) respectively. Using ultra-pure water for 6 months significantly reduced serum MPO, MDA levels (P<0.01), and they were further reduced after 12 months (P<0.01). Using ultra-pure water for 6 months significantly improved serum ALB levels (P<0.01), and it was further improved after 12 months (P<0.01). The levels of serum SOD were unchanged at two different times, (P>0.05) .Conclusion:1 After the use of ultra-pure water, the levels of serum MPO, MDA were significantly reduced, ultra-pure water dialysis can improve the oxidative stress levels in maintenance hemodialysis patients.2 With prolonged ultra-pure water dialysis, the levels of serum MPO, MDA reduced gradually, ultra-pure water dialysis can improve oxidatie stress level in maintenance hemodialysis patients continuously .
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