title: A potential role for immune activation in hemodialysis hypotension.
abstract: The necessary exposure of blood to biomembranes during hemodialysis has been viewed by many as an immunogenic challenge leading to an acute phase response. In this study we examined the relationship between hemodialysis-induced immune activation and intradialytic hypotension, using the acute phase reactant serum C-reactive protein (CRP) as a surrogate for immunogenic activation. The maximum percent change in mean arterial pressure (MAP) was found to correlate significantly with CRP (r = 0.67, p < 0.05) in nine consecutive patients with a history of symptomatic hypotension during hemodialysis. In contrast, no correlation was found between CRP and maximum percent change in MAP in eight consecutive hemodialysis patients without intradialytic hypotension. Since interleukin-6 (IL-6) is a major regulator of CRP, the relationship between these two proteins was examined. Plasma IL-6 levels were found to correlate both with CRP (r = 0.67, p < 0.05) and with mean maximum percent change in MAP (r = 0.70, p < 0.05) in hemodialysis patients with a prior history of hypotension. IL-6 levels did not correlate with CRP or blood pressure in the hemodynamically stable patients. The results suggest that immune activation working through IL-6, CRP and other cytokines may play a role in the pathogenesis of hemodialysis hypotension in some patients.
authors.affiliation: Department of Medicine, Medical College of Ohio, Toledo 43614, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tomita
authors.forename: D
authors.initials: D
authors.lastname: Malhotra
authors.forename: S
authors.initials: S
authors.lastname: Dheenan
authors.forename: J I
authors.initials: JI
authors.lastname: Shapiro
authors.forename: W L
authors.initials: WL
authors.lastname: Henrich
authors.forename: T J
authors.initials: TJ
authors.lastname: Santoro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001795:Blood Pressure Determination; D002097:C-Reactive Protein / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology*; D007109:Immunity / Q000502:physiology*; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein