The aim of this study was to evaluate the levels of malondialdehyde as an oxidative stress marker in the same hemodialysis patients after changing the quality of dialysate with ultrapure dialysis fluid. Methods. This prospective study concerns hemodialysis patients; all patients were in the first step treated with conventional dialysate, and in the second step (three months later) the same patients were treated with online produced ultrapure dialysis fluid. The malondialdehyde, C-reactive protein, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, fibrinogen, and albumin were quantified before the two steps. Results. Thirty-seven patients completed the study. Ultrapure dialysis fluid reduced but not significantly the malondialdehyde concentrations. Both dialysis fluids were associated with improvement in the malondialdehyde level before and after the hemodialysis session. In lipid parameters, there was a significant decrease with conventional dialysis fluid versus ultrapure dialysis fluid of triglycerides, total cholesterol, and high-density lipoprotein in patients’ blood. Instead, the level of low-density lipoprotein, fibrinogen, albumin, and C-reactive protein does not change significantly. Conclusion. The lipid parameters were improved for triglycerides and total cholesterol. Malondialdehyde increases following the hemodialysis session, and the conventional dialysate increased malondialdehyde levels more than the ultrapure dialysis but the differences were not statistically significant. 1. Introduction The chlorine compounds used to suppress bacterial growth in the potable water supply are removed when the water is treated for hemodialysis. It is almost impossible to completely prevent bacterial proliferation in the treated water and the dialysate. As a result, even though conventional dialysate meets the required quality standards, it usually contains some low level of microbiological contamination, including fragments of endotoxin and peptidoglycans and bacterial fragments [1–3]. These contaminants, sometimes collectively referred to as “cytokine-inducing substances,” cross both low-flux and high-flux hemodialysis membranes [2, 4] and stimulate cytokine production by inflammatory cells [5]. The use of dialysate of much higher microbiological purity improved this state of inflammation [6, 7]. General markers of inflammation such as serum C-reactive protein (CRP), ferritin, or fibrinogen are commonly used, but the oxidative stress referred to excessive production of reactive oxygen species (ROS) and inadequate
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