Biocompatibility of hemodialysis (HD) systems have been considerably improved. However, mortality and morbidity rates of patients have remained high, raising questions regarding the biocompatibility of current systems. In the present study, 70 patients on regular HD (51 males; mean age, 63 years; median duration of HD, 18 months) with high-performance membrane (polysulfone, 77%; polymethylmethacrylate, 23%) at Tohoku University Hospital were examined. Blood samples before and after HD, were subjected to measure apoptosis cells of white blood cells, plasma levels of the following molecules: myeloperoxidase (MPO), pentraxin 3 (PTX3), angiogenin, complements, and 17 cytokines. The main findings were as follows: significant decreases in leukocyte counts by dialysis, significant increases in apoptosis-positive leukocytes by dialysis (neutrophils and monocytes), and significant decrease in plasma angiogenin accompanying increase in plasma MPO and PTX3 levels, with no or only marginal changes in plasma pro-inflammatory cytokine levels and complement products by dialysis. The findings underlined the unsolved issue of bio-incompatibility of HD systems, and suggest the possible pathology of neutrophil apoptosis accompanying MPO release for the development of microinflammation in patients on HD.

Background: Methotrexate (MTX), a folic acid antimetabolite, is administered at a high dose for the treatment of diseases such as leukemia and malignant lymphoma. Often, an effort is made to reduce the adverse effects of MTX by monitoring MTX concentration in the blood and administering a high dose of leucovorin. However, side effects of MTX are still reported. MTX is metabolized in the liver and eliminated via the kidneys; hence, blood purification therapy is useful for the reduction of MTX blood concentration in case of renal impairment. Case presentation: We performed various types of blood purification therapies in four cases of MTX poisoning that accompanied renal impairment. Conclusions: Based on our results, we concluded that hemodialysis or hemoperfusion with an activated carbon absorption column was useful for the elimination of MTX from the blood. It is important to choose an appropriate blood purification method understanding the characteristics of each blood purification method.

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