Inflammatory signals associated with hemodialysis.
BACKGROUND
Inflammation is highly prevalent in chronic hemodialysis patients. Because hemodialysis involves the contact of blood with "foreign" surfaces, and the documented activation of several humoral and cellular pathways during the procedure, the hemodialysis procedure has been suggested as a potential source of inflammation in this patient population. Earlier studies did not provide clear-cut evidence of the potential contribution of the hemodialysis procedure to inflammation, as assessed by markers of inflammation such as cytokine levels and acute-phase protein production.


METHODS
Nine patients were studied using primed-constant infusion of l-(l-13C) leucine 2 hours before, during, and 2 hours after a single hemodialysis session. We evaluated the effects of hemodialysis on induction of interleukin-6 (IL-6) production as well as the fractional synthetic rates (FSR) of albumin and fibrinogen, two well-known acute-phase proteins.


RESULTS
During hemodialysis, albumin FSR and fibrinogen FSR increased significantly compared to the measurements obtained during baseline period. During this period, albumin and fibrinogen FSR increased 64% and 34%, respectively, compared to baseline (P < 0.05). While the increase in IL-6 concentration was modest during hemodialysis (14%), the levels further increased at the end of the 2-hour post-hemodialysis period (68% higher compared to baseline, P < 0.05). Fibrinogen FSR also demonstrated a further increase during the post-dialysis period (17% higher compared to the intradialytic period and 58% higher compared to baseline), while albumin FSR stabilized during this period.


CONCLUSIONS
The results provide clear evidence of hemodialysis-induced inflammatory response. The process is most notable during the 2-hour post-hemodialysis period.
Caglar
Kayser
K
Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, 1161 21st Avenue South & Garland, S-3223 MCN Nashville, TN 37232-2372, USA.
Peng
Youming
Y
Pupim
Lara B
LB
Flakoll
Paul J
PJ
Levenhagen
Deanna
D
Hakim
Raymond M
RM
Ikizler
T Alp
TA
D000328:Adult; D015415:Biomarkers; D002247:Carbon Isotopes; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D015850:Interleukin-6 / Q000097:blood; D007651:Keto Acids / Q000097:blood; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism
D015415:Biomarkers; D002247:Carbon Isotopes; D015850:Interleukin-6; D007651:Keto Acids; D012709:Serum Albumin; C013082:alpha-ketoisocaproic acid; D005340:Fibrinogen