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Is the dialysate fluid source of complement activating factors?

L Minetti, M L Broggi, G Civati

    Transactions - American Society for Artificial Internal Organs
    |January 1, 1985
    PubMed
    Summary
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    Dialysate can trigger complement activation during hemodialysis (HD). This study investigated membrane versus dialysate factors, finding LAL test-positive dialysate can cause complement activation, indicated by C3a plasma levels.

    Area of Science:

    • Nephrology
    • Immunology
    • Biomaterials Science

    Background:

    • Complement activation during hemodialysis (HD) can be triggered by either the dialysis membrane or the dialysate.
    • Understanding the source of complement activation is crucial for optimizing HD procedures and patient outcomes.

    Purpose of the Study:

    • To differentiate between membrane-induced and dialysate-induced complement activation during hemodialysis.
    • To assess the role of dialysate composition in complement activation.

    Main Methods:

    • Compared C3a plasma levels and neutrophil counts during HD using membranes with varying complement-activating potentials (cuprophane, PAN, PMMA).
    • Evaluated complement activation in high efficiency hemofiltration (HEHF) and hemofiltration without substitution fluid (HWSF) to isolate dialysate effects.

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  • Conducted sequential dialysis-ultrafiltration (UFD) experiments and performed Limulus Amebocyte Lysate (LAL) tests on dialysate.

    • Main Results:

    • Noncellulosic membranes (PAN, PMMA) showed minimal complement activation compared to cuprophane.
    • Complement activation, evidenced by C3a levels, was observed when LAL test-positive material was present in the dialysate.
    • Dialysate appears to be a significant source of complement activating factors.

    Conclusions:

    • Dialysate quality and composition play a critical role in complement activation during hemodialysis.
    • The presence of LAL test-positive substances in dialysate can lead to complement activation, independent of the membrane material.
    • Future research should focus on ensuring dialysate purity to mitigate complement-mediated adverse effects in hemodialysis patients.