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Complement activation in dialysis: effects on cytokines, lymphocyte activation and beta 2 microglobulin
M Gardinali1, A Calcagno, L Conciato
1Institute of Internal Medicine, University of Milano, Italy.
The International Journal of Artificial Organs
|June 1, 1994
Summary
Using sterile bicarbonate dialysate during hemodialysis (HD) prevents harmful cytokine release, even with complement-activating cuprophan membranes. This ensures patient safety by avoiding inflammatory responses associated with dialysis filters.
Area of Science:
- Nephrology
- Immunology
- Biomaterials Science
Background:
- Complement activation by hemodialysis (HD) membranes can generate anaphylatoxins.
- Anaphylatoxins, in the presence of endotoxins, may stimulate monocytes to produce pro-inflammatory cytokines like interleukin-1 (IL-1) and tumor necrosis factor (TNF).
- These cytokine releases can have detrimental effects on patients undergoing HD.
Purpose of the Study:
- To investigate if complement-activating (cuprophan) versus non-activating (polysulfone, polymethylmethacrylate, polyacrylonitrile) membranes influence cytokine levels in HD patients.
- To assess the impact of membrane type on IL-1, TNF, IL-2, and sIL-2r levels during HD.
- To evaluate the long-term effects of cuprophan membrane use on cytokine and receptor levels.
Main Methods:
- Comparison of cytokine and soluble IL-2 receptor levels in HD patients using different types of dialysis membranes.
- Utilized sterile bicarbonate solution as dialysate.
- Monitored cytokine levels throughout HD sessions and pre-dialysis levels over three months.
Main Results:
- No significant increases in IL-1, TNF, IL-2, and sIL-2r were observed during HD, even with cuprophan membranes, when sterile bicarbonate dialysate was used.
- Prolonged use of cuprophan membranes (three months) did not alter pre-dialysis cytokine and receptor levels.
- Complement-activating membranes did not affect beta 2 microglobulin levels.
Conclusions:
- The use of sterile bicarbonate solution as dialysate effectively prevents the increase of inflammatory cytokines during hemodialysis, irrespective of the membrane type.
- Hemodialysis membranes, including complement-activating ones like cuprophan, do not inherently elevate cytokine levels when used with sterile bicarbonate dialysate.
- This finding suggests a safe approach to hemodialysis, minimizing inflammatory complications associated with membrane-complement interactions.