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Is dialysis membrane type responsible for increased circulating adhesion molecules during chronic hemodialysis?
C Mrowka1, B Heintz, H G Sieberth
1Department of Internal Medicine and Nephrology, Aachen University of Technology, Germany.
Clinical Nephrology
|December 10, 1999
Summary
Patients undergoing hemodialysis (HD) show elevated vascular cell adhesion molecule-1 (VCAM-1) levels, regardless of dialysis membrane type. This suggests uremia, not membrane properties, drives these immunological changes during HD.
Area of Science:
- Nephrology
- Immunology
- Biomaterials Science
Background:
- Patients with chronic renal failure on maintenance hemodialysis (HD) experience immunologic alterations.
- Neutrophil function abnormalities are linked to disturbed cell adhesiveness, mediated by cytokines and adhesion molecules.
Purpose of the Study:
- To investigate serum concentrations of intercellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), and endothelial leukocyte adhesion molecule (E-selectin) in patients undergoing HD.
- To assess the impact of different dialysis membranes on these adhesion parameters and their correlation with cytokine levels.
Main Methods:
- Serum levels of ICAM-1, VCAM-1, and E-selectin were measured in 64 patients before and after HD using various dialysis membranes (cuprophane, cellulose, polysulfone, acrylonitrile).
- Circulating cytokines and their inhibitors were measured in parallel.
- Statistical analysis was performed to compare levels across membrane types and before/after HD sessions.
Main Results:
- VCAM-1 levels were significantly elevated with both low- and high-flux membranes.
- ICAM-1 levels were generally not elevated, except with one polysulfone membrane.
- VCAM-1 and E-selectin levels increased significantly during HD sessions for the entire study group.
- Cytokine inhibitors were elevated, while cytokine levels remained within normal ranges.
- Adhesion molecule levels did not correlate with the duration of end-stage renal disease or HD.
Conclusions:
- Elevated VCAM-1 suggests immunological alterations and cytokine-independent changes during HD are primarily driven by uremia, rather than specific membrane characteristics.
- ICAM-1 and E-selectin levels do not appear to be reliable markers for assessing the biocompatibility of dialysis membranes.
- These findings highlight the complex interplay between uremia, immune response, and dialysis procedures.