title: Effects of dialyser and dialysate on the acute phase reaction in clinical bicarbonate dialysis.
abstract: BACKGROUND
  In chronic haemodialysis (HD), morbidity may result from repetitive induction of the acute phase response, caused by a bioincompatible dialysis membrane and/or contaminated dialysate. In the present study, cytokine release (interleukin-6, IL-6) and subsequent production of acute phase proteins (C-reactive protein, CRP and secretory phospholipase A(2), sPLA(2)) were assessed to investigate whether the HD-induced acute phase reaction depends mainly on the type of membrane or on the sterility of the dialysate.
  
  
  METHODS
  In 11 patients, IL-6, CRP and sPLA(2) levels were assessed in blood samples drawn before (t(0)), at the end (t(180)) and 24 h after the start of HD (t(1440)). All patients were dialysed on Cuprammonium (CU) and Polysulphon (PS) dialysers and seven patients underwent an additional HD session on CU plus a dialysate filter (CUf).
  
  
  RESULTS
  IL-6 levels were increased significantly at t(180) compared with t(0) (P<0.02) with both CU and CUf. At t(1440), IL-6 levels had returned to baseline. In contrast, marked fluctuations did not occur during HD with PS. At t(180), IL-6 was significantly greater with CU and CUf devices, than with PS (P<0.02). Following HD with CU and CUf, a significant increase in CRP was observed at t(1440), compared with postdialysis values (P</=0.05). In addition, sPLA(2) values were markedly increased at t(1440), compared with t(180), but only significant in the case of CU (P=0.01). IL-6 levels at t(180) were significantly correlated with CRP (r=0.50, P<0.01) and sPLA(2) (r=0.47, P=0.01) values at t(1440). During HD with PS membranes, neither CRP nor sPLA(2) values were markedly changed.
  
  
  CONCLUSIONS
  In contrast to PS, both CU and CUf resulted in elevated IL-6 plasma levels at the end of HD, compared with t(0), which correlated with increased CRP and sPLA(2) values 24 h later. Therefore, the type of membrane, rather than the bacterial quality of the dialysate, seems to be responsible for the induction of the acute phase response during clinical bicarbonate HD.
authors.affiliation: Departments of Haemodialysis and Immunohematology, Medical Centre Alkmaar and St Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: W E
authors.initials: WE
authors.lastname: Schouten
authors.forename: M P
authors.initials: MP
authors.lastname: Grooteman
authors.forename: A J
authors.initials: AJ
authors.lastname: van Houte
authors.forename: M
authors.initials: M
authors.lastname: Schoorl
authors.forename: J
authors.initials: J
authors.lastname: van Limbeek
authors.forename: M J
authors.initials: MJ
authors.lastname: Nubé
mesh_terms: D000210:Acute-Phase Reaction / Q000209:etiology*; D000328:Adult; D000368:Aged; D001419:Bacteria / Q000254:growth & development; D001639:Bicarbonates / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000737:chemistry / Q000627:therapeutic use*; D004731:Endotoxins / Q000032:analysis; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010741:Phospholipases A / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*
chemical_list: D001639:Bicarbonates; D015314:Dialysis Solutions; D004731:Endotoxins; D015850:Interleukin-6; D008567:Membranes, Artificial; D002097:C-Reactive Protein; D010741:Phospholipases A