The effects of the dialysis membrane on cytokine release.

Abstract

The immune response requires the coordinated release of a network of cytokines including interleukin-1 (IL-1), tumor necrosis factor (TNF), and IL-2. The potential role of the dialysis membrane on the elaboration of these cytokines by peripheral blood mononuclear cells (PBMNC) harvested from hemodialysis patients was investigated in a prospective crossover study. Eight hemodialysis patients, chronically dialyzed with a biocompatible membrane, were sequentially dialyzed for 2 wk with new cuprophane membranes (Phase I), 2 wk with a low-flux, low-complement-activating membrane (Phase II), and then switched back for a further 2 wk of dialysis with a cuprophane membrane (Phase III). At the end of 2 wk of exposure to the cuprophane membrane, during both Phase I and Phase III, the ability of PBMNC to elaborate IL-1 beta, tumor necrosis factor-alpha, and IL-2, as well as soluble IL-2 receptors, in response to phytohemagglutinin was significantly reduced compared with their respective levels at the beginning of the phase; dialysis with a biocompatible membrane increased these levels, and at the end of 2 wk, the response of the PBMNC to phytohemagglutinin was close to that in normal controls. These findings may explain some of the conflicting results in the measurement of cytokine levels in hemodialysis patients and may have clinical implications.

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“…From studies in the nineties, when dialyzer membranes were less biocompatible and the water used for hemodialysis was of less microbiological quality than nowadays, it was suggested that interleukin-1 (IL-1), IL-6 or tumor necrosis factor (TNF) produced by peripheral blood mononuclear cells in the bloodstream were recognized as a pyrogenic signal by specific centers within the central nervous system (CNS). Such signals may induce the synthesis of prostaglandins that represent the central mediators of the coordinated response which may lead to a rise in core body temperature (28,31,32,33). IL-1 was found to be involved in both surges in body temperature and sleep induction (31).…”

“…IL-1 was found to be involved in both surges in body temperature and sleep induction (31). However, a slight increase in body temperature has also been observed in patients undergoing hemodialysis with uncontaminated dialysate (33). Body temperature may also rise as a result of heat load from the dialysis bath.…”