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Long-term influence of dialysis treatment on beta 2-microglobulin, interleukin-2 R and tumour necrosis factor
G Bandiani1, E Camaiora, D Farina
1Divisione di Nefrologia e Dialisi, Ospedale Civile San Andrea, La Spezia, Italy.
Abstract:
Recently much interest has been focused on the phenomena produced by the interaction between blood and dialytic membranes. The aim of this study was to evaluate beta 2-M, Il-2 and TNF changes in relation to the long-term use of different membranes (CU, PAN-AN69, PMMA, PS) and different dialytic treatments (HD, HDF, AFB). Plasma beta 2-M was significantly increased in patients dialysed with CU compared to synthetic membranes, and decreased in AFB compared to HD and HDF. Intradialytic changes of beta 2-M, corrected for haemoconcentration, resulted in a significant increase with CU and PMMA, while a decrease was found with PAN-AN69 and PS and during convective treatments, more evident during haemofiltration performed with sterile dialysate without acetate. I1-2R was increased in all patients compared to normal subjects, without any intradialytic change, regardless of the type of membrane used. TNF was in the normal range. The different decrease of beta 2-M observed with synthetic membranes, the stable intradialysis I1-2 R values during HD performed with membranes non-permeable to endotoxins and during AFB, and the absence of detectable TNF support the hypothesis that dialysate plays an important role in activating beta 2-M and cytokines, together with other factors.
Insights
This study examined how different dialysis membranes and treatments affect beta-2-microglobulin (beta 2-M) levels. Synthetic membranes and convective treatments, like haemofiltration, showed better results in reducing beta 2-M compared to cellulose (CU) membranes.
Area of Science:
- Nephrology
- Biomaterials Science
- Immunology
Background:
- Blood-membrane interactions are critical in dialysis.
- Long-term dialysis can impact patient biomarkers.
- Understanding membrane biocompatibility is essential for optimizing hemodialysis.
Purpose of the Study:
- To evaluate changes in beta-2-microglobulin (beta 2-M), Interleukin-2 receptor (Il-2R), and Tumor Necrosis Factor (TNF) with different dialysis membranes and treatments.
- To assess the impact of cellulose (CU), PAN-AN69, polymethyl methacrylate (PMMA), and polysulfone (PS) membranes on biomarker levels.
- To compare hemodialysis (HD), hemodiafiltration (HDF), and acetate-free biofiltration (AFB) effects on these biomarkers.
Main Methods:
- Plasma samples analyzed for beta 2-M, Il-2R, and TNF.
- Comparison of biomarker changes across four membrane types (CU, PAN-AN69, PMMA, PS).
- Evaluation of three dialysis modalities: HD, HDF, and AFB, with adjustments for hemoconcentration.
Main Results:
- Plasma beta 2-M increased with CU membranes but decreased with synthetic membranes and AFB.
- Intradialytic beta 2-M increased with CU and PMMA, decreased with PAN-AN69 and PS, and during convective treatments.
- Il-2R was elevated in all patients without intradialytic changes; TNF remained in the normal range.
Conclusions:
- Synthetic membranes and convective therapies are more effective in reducing beta 2-M compared to CU membranes.
- Stable Il-2R levels with endotoxin-impermeable membranes and AFB suggest dialysate quality is crucial.
- Findings support the hypothesis that dialysate composition and membrane properties influence biomarker activation during dialysis.