title: Elevated levels of tumor necrosis factor alpha in postdialysis fatigue.
abstract: Postdialysis fatigue (PDF) has been ascribed to excessive ultrafiltration and decline in osmolality during hemodialysis. We evaluated the potential role for the sommogenic cytokines, interleukin-1 beta (IL-1beta) and tumor necrosis factor alpha (TNFalpha), in the genesis of PDF Patients dialyzing with cuprophane membrane were assigned to PDF (N=25) and non-PDF (N=25) groups based on a fatigue index questionnaire. Pre- and postdialysis samples were obtained from 3 consecutive treatments and later assayed for serum levels of IL-1beta and TNFalpha by ELISA. Our results show significant intradialytic elevation of TNFalpha in both non-PDF groups (non-PDF: pre- 3.36+/-0.80 pg/ml to post 3.75+/-0.88 pg/ml, p<0.04; PDF: pre- 5.95+/-0.80 pg/ml to post- 8.66-/+1.35 pg/ml, p<0.02). The degree of intradialytic augmentation was significantly greater for TNFalpha in the PDF group (46+/-18% vs 11+/-5%; p<0.03). There were no significant intradialytic changes in serum levels of IL-1beta in either the PDF or non-PDF groups. There also were no significant differences in dialysis-related body weights, systolic blood pressures, or osmolalities. These findings suggest that TNFalpha may be involved in the pathogenesis of PDF.
authors.affiliation: Department of Medicine, United Health Services Hospitals, Binghamton, New York, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Dreisbach
authors.forename: T
authors.initials: T
authors.lastname: Hendrickson
authors.forename: D
authors.initials: D
authors.lastname: Beezhold
authors.forename: L A
authors.initials: LA
authors.lastname: Riesenberg
authors.forename: A H
authors.initials: AH
authors.lastname: Sklar
mesh_terms: D000368:Aged; D001672:Biocompatible Materials; D001794:Blood Pressure; D001835:Body Weight; D002482:Cellulose / Q000031:analogs & derivatives; D005221:Fatigue / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009994:Osmolar Concentration; D010045:Outpatients; D006435:Renal Dialysis / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D001672:Biocompatible Materials; D007375:Interleukin-1; D008567:Membranes, Artificial; D014409:Tumor Necrosis Factor-alpha; D002482:Cellulose; C009865:cuprammonium cellulose