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Chronic inflammation in hemodialysis: the role of contaminated dialysate
1Gemeinschaftspraxis für Nephrologie und Dialyse, Langenhagen, Deutschland. Glonnemann@t-online.de
Abstract:
Routine sodium bicarbonate-buffered dialysate is contaminated with predominantly gram-negative micro-organisms. These bacteria release pyrogenic substances such as endotoxins, peptidoglycans, exotoxins and fragments thereof. Pyrogens derived from contaminated dialysate either alone or in costimulation with activated complement components are the most important activators of circulating mononuclear cells in patients on chronic intermittent hemodialysis. Activated mononuclear cells release proinflammatory cytokines which are key mediators in acute and chronic inflammatory diseases associated with long-term hemodialysis therapy. Recent experimental and clinical data suggest that the use of pyrogen-free dialysate prevents activation of mononuclear cells and improves the state of chronic inflammation, as indicated by decreased plasma levels of C-reactive protein in chronic hemodialysis patients. Future clinical studies have to prove whether the use of pyrogen-free dialysate in combination with biocompatible dialyzer membranes and tubings reduces the incidence and severity of chronic inflammatory diseases (beta(2)-microglobulin amyloidosis, muscle protein wasting, atherosclerosis) in long-term hemodialysis patients.
Insights
Pyrogens in routine hemodialysis fluid activate immune cells, causing inflammation. Using pyrogen-free dialysate may reduce this activation and improve chronic inflammation in hemodialysis patients.
Area of Science:
- Nephrology
- Immunology
- Biotechnology
Background:
- Routine sodium bicarbonate-buffered dialysate is frequently contaminated with gram-negative microorganisms.
- These bacteria release pyrogenic substances, including endotoxins and exotoxins.
- Pyrogens from contaminated dialysate activate mononuclear cells in hemodialysis patients, leading to inflammation.
Purpose of the Study:
- To investigate the role of pyrogens in dialysate-induced inflammation in hemodialysis patients.
- To evaluate the potential benefits of pyrogen-free dialysate in managing chronic inflammation.
Main Methods:
- Review of experimental and clinical data on pyrogen contamination in hemodialysis.
- Analysis of mononuclear cell activation and cytokine release in response to pyrogens.
- Assessment of C-reactive protein levels as an indicator of inflammation.
Main Results:
- Contaminated dialysate pyrogens are key activators of mononuclear cells in hemodialysis patients.
- Activated mononuclear cells release proinflammatory cytokines, contributing to hemodialysis-associated inflammation.
- Pyrogen-free dialysate has shown potential in preventing mononuclear cell activation and reducing inflammation markers like C-reactive protein.
Conclusions:
- Pyrogen-free dialysate may mitigate chronic inflammation in hemodialysis patients.
- Further clinical studies are needed to confirm the efficacy of pyrogen-free dialysate in preventing long-term hemodialysis complications.
- Combining pyrogen-free dialysate with biocompatible materials could reduce the incidence and severity of inflammatory diseases in hemodialysis patients.
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