[Systemic inflammatory reactions to extracorporeal therapy measures (I): Hemodialysis and hemofiltration]

Hemodialysis and hemofiltration (intermittent or continuous) are the most frequently applied extracorporeal treatment strategies, enabling survival of patients with acute or chronic renal failure. To a various degree on the other hand they induce an undesirable inflammatory response summarized as bioincompatibility. Apart from the quality of the dialysate the composition of the dialytic membrane itself appears to be of very great importance in triggering this inflammatory process. The main humoral and cellular mechanisms underlying this inflammatory response are the activation of complement cascade, the activation of blood cells, the release of cytokines and the induction of nitric oxide synthesis. Various laboratory tests have confirmed a lower degree of inflammatory response on using synthetic membranes in comparison with cuprophane membranes. The importance of these differences in the treatment of dialysis patients with respecto to intradialytic complications and long-term morbidity and mortality, is, however, still a matter of debate. The results of clinical investigations to date are conflicting and have not yet clearly proven, whether implementation of synthetic membranes is of any benefit to dialysis patients or not. Apart from the cost factor there is no argument in favour of using cuprophane membranes.