Blood–membrane interaction in hemodialysis leads to increased cytokine production

Luger, Anton; Kovařík, Josef; Stummvoll, Hans-Krister; Urbanska, Agatha; Luger, Thomas A.

doi:10.1038/ki.1987.175

Cited by 197 publications

(95 citation statements)

References 22 publications

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“…Finally, it should be emphasized that our data pertain only to acute changes during and immediately after dialysis and do not necessarily exclude the possibility that repeated cytokine release with hemodialysis might enhance protein catabolism over a long period of time (30,31 ).…”

Section: Methodsmentioning

confidence: 99%

The effect of hemodialysis on protein metabolism. A leucine kinetic study.

Lim¹,

Bier²,

Flanigan³

et al. 1993

J. Clin. Invest.

107

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To assess the effect of hemodialysis on protein metabolism, leucine flux was measured in seven patients before, during, and after high efficiency hemodialysis using cuprophane dialyzers and bicarbonate dialysate during a primed-constant infusion of L-I1-'3CIleucine. The kinetics ;Lsmol/kg per h, mean±SDJ are as follows: leucine appearance into the plasma leucine pool was 86±28, 80±28, and 85±25, respectively, before, during, and after dialysis. Leucine appearance into the whole body leucine pool, derived from plasma l1-'3Cla-ketoisocaproate enrichment, was 118±31, 118±31, and 114±28 before, during, and after dialysis, respectively. In the absence of leucine intake, appearance rate reflects protein degradation, which was clearly unaffected by dialysis. Leucine oxidation rate was 17.3±7.8 before, decreased to 13.8±7.8 during, and increased to 18.9±10.3 after dialysis (P = 0.027). Leucine protein incorporation was 101±26 before, was reduced to 89±23 during, and returned to 95±23 after dialysis (P = 0.13). Leucine net balance, the difference between leucine protein incorporation and leucine release from endogenous degradation, was -173±7.8 before, decreased to -28.5±11.0 during, and returned to -18.9±10.3 after dialysis (P < 0.0001). This markedly more negative leucine balance during dialysis was accountable by dialysate leucine loss, which was 14.4±6.2 umol/kg per h. These data suggest that hemodialysis using a cuprophane membrane did not acutely induce protein degradation. It was, nevertheless, a net catabolic event because protein synthesis was reduced and amino acid was lost into the dialysate. (J. Clin. Invest. 1993 91:2429-2436

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Section: Methodsmentioning

confidence: 99%

The effect of hemodialysis on protein metabolism. A leucine kinetic study.

Lim¹,

Bier²,

Flanigan³

et al. 1993

J. Clin. Invest.

107

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show abstract

“…acidosis (11), glucose intolerance (12), increased cytokine levels (13), and other hormonal derangements (14). Among these last disturbances, high parathyroid hormone (PTH) levels, frequently observed in CRF patients, may be implicated in the nutritional abnormalities found in these patients.…”

Section: Introductionmentioning

confidence: 99%

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

Rezende

Cuppari

Carvalho

et al. 2000

Braz J Med Biol Res

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The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group). The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat), 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO 3 ) and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group). Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg -1 day -1 ; P = 0.08). Except for blood urea nitrogen (86.4 vs 75.7 mg/ dl), alkaline phosphatase (175 vs 65 U/l) and PTH (898 vs 155 pg/ml), no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05) and length of dialysis (r = 0.53; P<0.05) only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism.

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“…Thus in-vitro data clearly support the hypothesis of IL-1 to account for PLA 2 activation. However, the invivo observations are more difficult to reconcile with that hypothesis, since only some [38][39][40] but not all [41][42][43] studies reveal increased concentrations of IL-1 P in blood. In line with our observation of a more pronounced PLA 2 activation possibly mediated through IL-1 release with a more complementactivating membrane is the recent report from Schindler et ah [14] demonstrating an increased gene expression of IL-1 (3 in peripheral blood mononuclear cells leaving the dialyser 5 min after start of haemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Haemodialysis activates phospholipase A2 enzyme

Vishwanath

Fux

Uehlinger

et al. 1996

Nephrology Dialysis Transplantation

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Background. Clinical and experimental evidence suggest that haemodialysis (HD) procedure is an inflammatory process. For the production of proinflammatory lipid mediators in many inflammatory reactions, the release of arachidonic acid by phospholipase A 2 (PLA 2 ) enzyme is a prerequisite. Therefore, the purpose of the present investigation was to establish whether the activity of PLA 2 increases during HD and whether the increase depends on the type of dialyser used. Methods. We performed dialysis in eight chronic HD patients. Blood samples entering and leaving the dialyser were obtained before and at 15, 60, 120 and 180 min after the dialysis was started, on one occasion using a cuprophane and on another occasion a cellulose triacetate dialyser. PLA 2 activity was assessed in crude plasma and in plasma extract. Results. PLA 2 activity in plasma extract exhibited similar biochemical properties to that of inflammatory human synovial fluid PLA 2 enzyme which is of group II PLA 2 . PLA 2 activity in crude plasma represents a type of PLA 2 other than the synovial type. In HD patients, baseline PLA 2 activities in crude plasma and plasma extract were significantly increased when compared to normal subjects. An increase in PLA 2 activity was observed in crude plasma with a peak appearing at 15 min when the patients were dialysed with cuprophane and cellulose triacetate membranes. This increase was observed in both arterial and venous blood samples and was more pronounced when the patients were dialysed with cuprophane than with cellulose triacetate membranes. When PLA 2 was assessed in plasma extract, the activity increased only with cuprophane but not with cellulose triacetate membranes. Conclusion. PLA 2 activity in plasma is increased in HD patients and increases during the dialysis procedure to a greater extent with a less biocompatible membrane. Continuous activation of PLA 2 might be relevant for long-term deleterious consequences of HD.

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Blood–membrane interaction in hemodialysis leads to increased cytokine production

Cited by 197 publications

References 22 publications

The effect of hemodialysis on protein metabolism. A leucine kinetic study.

The effect of hemodialysis on protein metabolism. A leucine kinetic study.

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

Haemodialysis activates phospholipase A2 enzyme

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