title: Effects of different levels of endotoxin contamination on inflammatory cytokine production by peripheral blood mononuclear cells after high-flux hemodialysis.
abstract: BACKGROUND
  In Thailand, dialysate endotoxin contamination levels vary from less than 0.001 to 2.0 EU/ml. This difference has prompted an investigation on the production of proinflammatory cytokines and counter-inflammatory mediators of peripheral blood mononuclear cells (PBMCs) after high-flux dialysis.
  
  
  METHODS
  Patients from four hemodialysis (HD) centers who met the inclusion/exclusion criteria were enrolled into the study. PBMCs were isolated by Ficoll density gradient centrifugation and cultured. Supernatants were tested for interleukin 6 (IL-6), IL-1β and IL-1 receptor antagonist (IL-1Ra) concentration by ELISA.
  
  
  RESULTS
  HD centers 1, 2, 3 and 4 had mean dialysate endotoxin contamination levels of 0.001, 0.026, 0.558 and 1.960 EU/ml, respectively. HD center 4 had the highest levels of IL-6 (1,052.3 ± 240.7 pg/10(6) PBMCs), IL-1β (1,297.1 ± 334.6 pg/10(6) PBMCs) and IL-1Ra (2,713.4 ± 1,255.3 pg/10(6) PBMCs). There were no significant differences in cytokine production between HD centers 1 and 2.
  
  
  CONCLUSIONS
  Our study showed that ultrapure dialysate can minimize the risk of stimulating inflammatory cells. Ultrapure dialysate may prevent or delay endotoxin exposure-related complications.
authors: Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. kearkiat@hotmail.com
authors: Kearkiat
authors: K
authors: Praditpornsilpa
authors: Khajohn
authors: K
authors: Tiranathanagul
authors: Paweena
authors: P
authors: Susantitaphong
authors: Pisut
authors: P
authors: Katavetin
authors: Thananda
authors: T
authors: Trakarnvanich
authors: Natavudh
authors: N
authors: Townamchai
authors: Talerngsak
authors: T
authors: Kanjanabuch
authors: Yingyos
authors: Y
authors: Avihingsanon
authors: Kriang
authors: K
authors: Tungsanga
authors: Somchai
authors: S
authors: Eiam-Ong
mesh_terms: D000328:Adult; D000368:Aged; D004731:Endotoxins / Q000276:immunology / Q000494:pharmacology*; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D015312:Hemodialysis Solutions / Q000032:analysis / Q000494:pharmacology*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000032:analysis / Q000096:biosynthesis; D053583:Interleukin-1beta / Q000032:analysis / Q000096:biosynthesis; D015850:Interleukin-6 / Q000032:analysis / Q000096:biosynthesis; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D007963:Leukocytes, Mononuclear / Q000187:drug effects* / Q000276:immunology; D008213:Lymphocyte Activation / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013785:Thailand
chemical_list: D004731:Endotoxins; D015312:Hemodialysis Solutions; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; D015850:Interleukin-6