Fever in uremia: production of leukocytic pyrogen by chronic dialysis patients

Uremic patients frequently have low baseline temperatures and a blunted febrile response to infection. We investigated the first step in the generation of a febrile response, the production of leukocytic pyrogen (LP) by blood monocytes, in 12 patients on chronic hemodialysis, five patients on continuous ambulatory peritoneal dialysis (CAPD), and 17 control subjects. No significant differences were found in the amount of LP produced by hemodialysis patients, CAPD patients, and control subjects. Uremic serum did not decrease LP production by monocytes from control subjects. Hemodialysis patients who were consistently hypothermic (mean oral predialysis temperature less than or equal to 35.6 degrees F) produced as much LP as those with more normal oral temperatures (mean oral predialysis temperature greater than or equal to 36.8 degrees F). Decreased production of LP does not explain the blunted febrile response noted in patients with chronic renal failure.