The effect of ultrafiltered dialysate on the cellular content of interleukin-1 receptor antagonist in patients on chronic hemodialysis.
We investigated the effect of dialysate ultrafiltration on the content of IL-1 receptor antagonist (IL-1Ra) in mononuclear cells (PBMC) as a marker of the inflammatory response. 11 patients on Cuprophan dialyzers were randomly assigned to treatment with standard bicarbonate dialysate first and then to ultrafiltered dialysate or the reverse order in a crossover design. In each treatment period (at least 4 weeks) weekly separations of PBMC were performed before the start of dialysis. Cellular content of IL-1Ra was determined in PBMC that were frozen immediately after separation; all values of IL-1Ra in each treatment period were averaged. The dialysate contained a median of 148 (range, 61-400) colony-forming units without dialysate filter; no bacterial growth was detected in ultrafiltered dialysate. The median endotoxin content was 80 pg/ml in nonfiltered dialysate; endotoxin was below 5 pg/ml in all ultrafiltered dialysate samples. Cellular content of IL-1Ra decreased in all but 1 patient with the use of ultrafiltered dialysate (mean +/- SEM: 1,467 +/- 113 pg/ml without dialysate filter vs. 1,166 +/- 104 pg/ml with filter, p = 0.016). The present study demonstrates that the bacterial contamination of the dialysate induces a systemic inflammatory response in hemodialysis patients.
Schindler
R
R
Department of Nephrology, Medizinische Hochschule Hannover, Germany.
Lonnemann
G
G
Schäffer
J
J
Shaldon
S
S
Koch
K M
KM
Krautzig
S
S
D001419:Bacteria / Q000302:isolation & purification; D018592:Cross-Over Studies; D015312:Hemodialysis Solutions / Q000009:adverse effects / Q000302:isolation & purification; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors; D006435:Renal Dialysis; D012795:Sialoglycoproteins / Q000097:blood*; D014462:Ultrafiltration
D015312:Hemodialysis Solutions; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D017472:Receptors, Interleukin-1; D012795:Sialoglycoproteins