Hemodialysis Hypotension: The Interleukin Hypothesis

Henderson, Lee W.; Koch, Karl-Martin; Dinarello, Charles A.; Shaldon, Stanley

doi:10.1159/000166438

Cited by 258 publications

(91 citation statements)

References 17 publications

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“…Because of the similarities between their biological effects and clinical symptoms in chronic hemodialysis patients this had led to the interleukin hypothesis. The latter relies on the release of hemodialysis-induced proinflammatory cytokines such as IL-1ß, IL-6, TNF-· [22].…”

Section: Discussionmentioning

confidence: 99%

Ex vivo Flow Cytometry Determination of Intracytoplasmic Expression of IL-2, IL-6, IFN-γ, and TNF-α in Monocytes and T Lymphocytes, in Chronic Hemodialysis Patients

et al. 2000

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Aims: To determine the intracytoplasmic expression of TNF-α, IL-2, IL-6 and IFN-γ, ex vivo and in vitro, in both monocytes and T lymphocytes by flow cytometry after appropriate stimulation using phorbol myristate acetate (PMA)/ionomycin or lipopolysaccharides (LPS) in the presence of monensin, in order to assess the bio(in)compatibility of different dialysis membranes. Methods: We examined monocytes and T lymphocytes taken from chronic hemodialysis patients (using either cuprophane (CUP), n = 6; polyacrylonitrile (AN 69), n = 6; or polysulfone (PS), n = 6 membranes), before and after a dialysis session. We compared the results with those obtained from end-stage chronic renal failure patients (n = 3) and healthy volunteers (n = 11). Results: Before any stimulation there was a statistically significant difference in the percentages of TNF-α, IL-6, and IFN-γ- expressing monocytes with respect to the dialysis membrane used. The highest percentages were observed for CUP and AN69 patients with figures of around 30% for each cytokine; the lowest percentages were found in PS patients and healthy volunteers. One hour after LPS stimulation the patterns remained unchanged for TNF-α and IFN-γ, whereas the percentages of IL-6-expressing cells in PS patients and in healthy volunteers reached the figures obtained in the other groups. When we examined the percentage of IFN-γ-, TNF-α- and IL-6-expressing monocytes in patients before and after a dialysis session, before any stimulation, we found that the results were significantly different for the three membranes (p = 0.01). Thus, a dialysis session with polysulfone membranes had no significant effect on the precentages of IFN-γ-, TNF-α-, and IL-6-expressing monocytes, whereas percentages were significantly lower after the dialysis session when using cuprophane or AN69 membranes, suggesting a release of these cytokines by the monocytes during dialysis. A significant number of IFN-γ- and IL-2-expressing T lymphocytes were only detected after 18 hours of PMA/ionomycin stimulation. The percentages of IFN-γ-expressing T cells recorded for the different membranes were not statistically different from those recorded for healthy subjects or pre-dialysis patients, i.e., they were between 11.5 and 20%. However, the percentages of IL-2-expressing T lymphocytes were significantly different between the 5 groups, i.e., 31.3, 30.5, 18.6, 13.9 and 7.6%, respectively, for CUP patients, pre-dialysis patients, healthy volunteers, PS and AN69 patients. This suggests that pre-dialysis and CUP patients have, at baseline, a stimulation of their T lymphocytes. Finally, a 4-hour dialysis session had no impact on the percentages of IL-2-expressing T lymphocytes, whereas it was associated with a significant decrease in the percentage of IFN-γ-expressing cells, but only when cuprophane membranes were used. Conclusion: Cytokine flow cytometry enables one to study, ex vivo, i.e., without any stimulation of the cells, and in vitro after appropriate stimulation, the bio(in)compatibility of dialysis membranes ...

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Section: Discussionmentioning

confidence: 99%

Ex vivo Flow Cytometry Determination of Intracytoplasmic Expression of IL-2, IL-6, IFN-γ, and TNF-α in Monocytes and T Lymphocytes, in Chronic Hemodialysis Patients

et al. 2000

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“…Patients with chronic renal failure (CRF) undergoing hemodialysis are individuals whose immune system is significantly compromised. Among the changes related to immunodepression detected in these patients, we can cite the presence of uremic toxins which mainly impair the granulocytic but also the lymphocytic function 3,4,9,14,21,23 ; malnutrition, present in a large number of patients 35 ; vitamin deficiencies, resulting either from inadequate intake, or from losses during dialysis procedures 9,14,23 ; blood exposure to artificial membranes with the inflammatory activation and release of cytokines, causing the activation of monocytes and the complement cascade that lead to a change in the immune response against infectious agents 28 , changes in the coagulation cascade; frequent and repeated episodes of per-dialysis hypotension, with the activation of leukocytes, lymphocytes, and nitric oxide; platelet dysfunction and anemia causing specific immunological changes 5,11,12,31 ; breaking of the cutaneous immune barrier and that of the mucosal surfaces, mainly due to functional changes in the surface of immunoglobulins, neutrophils, platelets, and the coagulation cascade 9,14,17,30 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Intestinal Parasitism and Associated Symptomatology Among Hemodialysis Patients

Gil

Barros

Macedo

et al. 2013

Rev. Inst. Med. trop. S. Paulo

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SUMMARYIntestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05). Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with chronic renal failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic potential can develop serious clinical complications influencing the success of transplantation. This fact, coupled with the high prevalence of intestinal parasites and the dissociation between symptoms and infection in CRF patients, suggests that the stool test should be incorporated in routine propedeutics. Furthermore, preventive measures for the acquisition of parasites through the fecal-oral contamination route should be introduced.

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“…Since the publication of the "IL hypothesis," the effects of uremia and HD on the production of especially IL-1, TNF, and IL-6 by peripheral mononuclear cells have been studied extensively (36). An increase in cytokine generation might increase CT by stimulation of the anterior hypothalamic area (37).…”

Section: Discussionmentioning

confidence: 99%

Effect of Ultrafiltration on Thermal Variables, Skin Temperature, Skin Blood Flow, and Energy Expenditure during Ultrapure Hemodialysis

Sande¹,

Rosales²,

Brener³

et al. 2005

Journal of the American Society of Nephrology

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The cause of the increase in core temperature (CT) during hemodialysis (HD) is still under debate. It has been suggested that peripheral vasoconstriction as a result of hypovolemia, leading to a reduced dissipation of heat from the skin, is the main cause of this increase in CT. If so, then it would be expected that extracorporeal heat flow (Jex) needed to maintain a stable CT (isothermic; T-control ‫؍‬ 0, no change in CT) is largely different between body temperature control HD combined with ultrafiltration (UF) and body temperature control HD without UF (isovolemic). Consequently, significant differences in ⌬CT would be expected between isovolemic HD and HD combined with UF at zero Jex (thermoneutral; E-control ‫؍‬ 0, no supply or removal of thermal energy to and from the extracorporeal circulation). During the latter treatment, the CT is expected to increase. In this study, changes in thermal variables (CT and Jex), skin blood flow, energy expenditure, and cytokines (TNF-␣, IL-1 receptor antagonist, and IL-6) were compared in 13 patients, each undergoing body temperature control (T-control ‫؍‬ 0) HD without and with UF and energy-neutral (E-control ‫؍‬ 0) HD without and with UF. CT increased equally during energy-neutral treatments, with (0.32 ؎ 0.16°C; P ‫؍‬ 0.000) and without (0.27 ؎ 0.29°C; P ‫؍‬ 0.006) UF. In body temperature control treatments, the relationship between Jex and UF tended to be significant (r ‫؍‬ ؊0.51; P ‫؍‬ 0.07); however, there was no significant difference in cooling requirements regardless of whether treatments were done without (؊17.9 ؎ 9.3W) or with UF (؊17.8 ؎ 13.27W). Changes in energy expenditure did not differ among the four treatment modes. There were no significant differences in pre-and postdialysis levels of cytokines within or between treatments. Although fluid removal has an effect on thermal variables, no single mechanism seems to be responsible for the increased heat accumulation during HD. A n inadequate vascular response to hypovolemia is an important contributory factor to intradialytic hypotension. Although various mechanisms have been implicated in the pathogenesis of impaired vascular response during hemodialysis (HD) (1-7), there are strong indications that this phenomenon is often related to changes in body temperature and extracorporeal blood temperature (8 -22).We and others have observed that the core temperature (CT) increased during standard-temperature (37 to 38°C) dialysis (16,18 -24) even with net energy loss from the patient to the extracorporeal system. This phenomenon strongly suggests that the dialysis procedure itself leads to internal heat accumulation. It has been observed that 4 h of standard dialysis leads to a positive internal heat balance of approximately 300 kJ, which represents approximately 30% of the energy expenditure (EEvmax) of the patient (25). The internal heat accumulation might very well be responsible for the impaired vascular response during HD, as the thermoregulatory response (leading to dilation of thermoregulatory vessels) wi...

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Hemodialysis Hypotension: The Interleukin Hypothesis

Cited by 258 publications

References 17 publications

Ex vivo Flow Cytometry Determination of Intracytoplasmic Expression of IL-2, IL-6, IFN-γ, and TNF-α in Monocytes and T Lymphocytes, in Chronic Hemodialysis Patients

Ex vivo Flow Cytometry Determination of Intracytoplasmic Expression of IL-2, IL-6, IFN-γ, and TNF-α in Monocytes and T Lymphocytes, in Chronic Hemodialysis Patients

Prevalence of Intestinal Parasitism and Associated Symptomatology Among Hemodialysis Patients

Effect of Ultrafiltration on Thermal Variables, Skin Temperature, Skin Blood Flow, and Energy Expenditure during Ultrapure Hemodialysis

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