Blood purification procedures and their related short- and long-term effect on patients.
At present, approximately 1 million patients are on chronic hemodialysis in the world. Some patients have been dialyzed for more than 20 years. However, chronic hemodialysis produces a new type of disease known as chronic hemodialysis syndrome. Procedurally induced immunomodulation may be the cause of this syndrome. Hematological changes imposed by this extracorporeal circulation for hemodialysis are discussed in this article. A comparison with procedurally induced immunomodulation by apheresis procedures is also provided. This repeated exposure of the blood-to-blood purification device with a large foreign surface produces quite substantial immunological effects to the patient. Thus, further studies were necessary to analyze more clearly the adaptation mechanism of the human defense system. On the basis of these studies, the following conclusion could be derived. Typically, Stage 1, human adaptation to the implanted or applied man-made machine, would be 48 h and could be divided into 3 phases. They would be Phase I (15-30 min) leukocyte storage, Phase II (2-24 h) leukocyte release, and Phase III (24-48 h) completion of the proper leukocyte response. To adapt hematologically in 48 h, the patient may experience 3 phases of adaptation reactions. When patients are subjected to extracorporeal circulation, the immunosuppressive state of hemodialysis is hypothesized through these studies.
Nosé
Yukihiko
Y
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. YNose@bcm.tmc.edu
D000276:Adjuvants, Immunologic; D001781:Blood Component Removal; D003165:Complement System Proteins / Q000032:analysis; D005112:Extracorporeal Circulation; D006801:Humans; D007114:Immunization; D007962:Leukocytes; D008567:Membranes, Artificial; D006435:Renal Dialysis / Q000009:adverse effects* / Q000191:economics; D013577:Syndrome
D000276:Adjuvants, Immunologic; D008567:Membranes, Artificial; D003165:Complement System Proteins