Effects of dialyser and dialysate on the acute phase reaction in clinical bicarbonate dialysis.
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.
Schouten
W E
WE
Departments of Haemodialysis and Immunohematology, Medical Centre Alkmaar and St Maartenskliniek, Nijmegen, The Netherlands.
Grooteman
M P
MP
van Houte
A J
AJ
Schoorl
M
M
van Limbeek
J
J
Nubé
M J
MJ
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*
D001639:Bicarbonates; D015314:Dialysis Solutions; D004731:Endotoxins; D015850:Interleukin-6; D008567:Membranes, Artificial; D002097:C-Reactive Protein; D010741:Phospholipases A