Dialyzer membrane type and reuse practice influence polymorphonuclear leukocyte function in hemodialysis patients.
BACKGROUND
Polymorphonuclear leukocyte (PMNL) production of reactive oxygen species (ROS) has been linked to hemodialysis (HD) associated morbidity. The effect of dialyzer membrane type and reuse on PMNL function has not been clearly defined.


METHODS
The present report is a cross-sectional study undertaken in a cohort of patients undergoing regular HD, at enrollment into the Hemodialysis (HEMO) Study, to study the association between patient and dialysis-related factors and PMNL function. PMNL function was assessed by measuring PMA- and N-formyl methionyl-leucyl-phenylalanine (fMLP) -induced respiratory burst, and phagocytic activity toward Staphylococcus aureus.


RESULTS
PMNL from patients dialyzed with polysulphone (PS) or cuprophane (CU) membranes showed higher PMA-induced respiratory burst activity compared with those exposed to substituted cellulose (cellulose acetate, cellulose triacetate, CA/CT) membranes, regardless of dialyzer reuse. The use of bleach as a cleansing agent during reuse was associated with higher PMA-induced PMNL superoxide production, as was the use of renalin when compared to aldehydes. In a subgroup of patients using PS dialyzers, reuse itself was associated with higher fMLP-induced superoxide production. The type of bleach-germicide combination during reuse showed that use of renalin as a germicide was also associated with higher PMNL phagocytosis index. The number of years on HD correlated inversely with PMA-induced PMNL superoxide response. Weaker PMNL response to fMLP was associated with greater comorbidity and poor functional status as quantified by Index of Coexisting Diseases (ICED) and Karnofsky scores, respectively.


CONCLUSIONS
Our results indicate that dialyzer membrane type and the reuse process influence the oxidative response of PMNL among HD patients. The implications of these observations on clinical morbidity need to be further evaluated in prospective studies.
Rao
Madhumathi
M
Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
Guo
Daqing
D
Jaber
Bertrand L
BL
Sundaram
Sumuk
S
Cendoroglo
Miguel
M
King
Andrew J
AJ
Pereira
Brian J G
BJ
Balakrishnan
Vaidyanathapuram S
VS
D000368:Aged; D002273:Carcinogens / Q000494:pharmacology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009240:N-Formylmethionine Leucyl-Phenylalanine / Q000494:pharmacology; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology* / Q000378:metabolism; D010587:Phagocytosis; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D016897:Respiratory Burst; D013481:Superoxides / Q000378:metabolism; D013755:Tetradecanoylphorbol Acetate / Q000494:pharmacology
D002273:Carcinogens; D008567:Membranes, Artificial; D013481:Superoxides; D009240:N-Formylmethionine Leucyl-Phenylalanine; D013755:Tetradecanoylphorbol Acetate