Induction of tumour necrosis factor-alpha during haemodialysis. Influence of the membrane type

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Abstract
Some of the secondary clinical effects induced by long-term haemodialysis in patients with end-stage renal failure have been related to an increased production of interleukin-1 (IL-1). We investigated the role of another cytokine which shares a number of biological properties with IL-1, tumour necrosis factor-alpha (TNF-α). In long-term haemodialysed patients, we found at the beginning of the dialysis increased plasma TNF-α levels and enhanced monocyte capacity to produce TNF-α spontaneously ex vivo. Non-haemodialysed uraemic patients also presented increased plasma TNF-α levels. During dialysis with cellulose acetate (CA) or polysulphone (PS) membranes, plasma TNF-α levels and the spontaneous and lipopolysaccharide-induced production of TNF-α by monocytes remained at predialysis levels. In contrast, when cuprophane membranes were used, there was a significant increase in plasma TNF-α levels and in both spontaneous (10-fold) and lipopolysaccharide-induced (seven-fold) ex vivo TNF-α production by monocytes. These results suggest that monocytes are stimulated during haemodialysis with the poorly biocompatible cuprophane membrane.