Tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-1 receptor antagonist in dialysate and serum from patients on continuous ambulatory peritoneal dialysis.
Dialysate and serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and IL-1-ra were investigated in 20 patients on continuous ambulatory peritoneal dialysis (CAPD), who altogether had 30 episodes of peritonitis. Bacterial growth was found in 25 (83%) of the dialysate samples. Staphylococcus epidermidis was the single most common microorganism, found in 44% of the culture-verified peritonitis. Samples from dialysate bags were obtained during the first month of dialysis and during peritonitis from the first three bags on day 1 (the day of admittance) and from night bags on days 3 and 10. Serum samples were drawn on days 1 and 10. The peak concentrations of cytokines occurred on the first day of infection. In dialysates, TNF-alpha was elevated in 96% of the patients, with a peak median concentration of 160 pg/mL (range, <15 to 4,400 pg/mL). Seventy-five percent of the dialysates had elevated IL-1-beta, with the highest median level of 52 pg/mL (range, <10 to 940 pg/mL), whereas all patients had elevated IL-1 ra, with a peak median value of 10,300 pg/mL (range, 470 to 79,000 pg/mL). TNF-alpha, IL-1 beta, and IL-Ira were significantly higher than in corresponding noninfected samples (TNF-alpha median value, <15 pg/mL; IL-1 beta, <10 pg/mL; and IL-1-ra, 150 pg/mL; P < 0.0001, P < 0.002, and P < 0.001, respectively). In serum, elevated TNF-alpha levels were found in 92% of the episodes, but the median levels were less than one third of the corresponding lavage levels. IL-1-beta was detected in 8% of the episodes and, although IL-1-ra was found in 92% of the patients, the dialysate levels were more than 15 times higher. In dialysate, a correlation was observed for TNF-alpha and IL-Ira and also between IL-1-beta and IL-Ira. IL-1 beta and IL-1-ra also correlated with the previously analyzed IL-6, and IL-1-beta correlated with the previously analyzed IL-8. Patients infected with high virulent strains had higher cytokine levels as compared with those infected with low virulent strains. In conclusion, our study shows markedly elevated TNF-alpha, IL-1 beta, and IL-1-ra levels in the acute stage in CAPD patients with peritonitis.
Brauner
A
A
Department of Microbiology, Karolinska Hospital, Stockholm, Sweden.
Hylander
B
B
Wretlind
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007375:Interleukin-1 / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000706:statistics & numerical data; D010538:Peritonitis / Q000097:blood / Q000382:microbiology / Q000628:therapy; D011446:Prospective Studies; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D015314:Dialysis Solutions; D007375:Interleukin-1; D017472:Receptors, Interleukin-1; D014409:Tumor Necrosis Factor-alpha