Effects of dialyser and dialysate on the acute phase reaction in clinical bicarbonate dialysis

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Abstract
Background. In chronic haemodialysis (HD), morbidity may result from repetitive induction of the acute phase response, caused by a bioincompatible dialysis membrane and/or contaminated dialysate. In the present study, cytokine release (interleukin-6, IL-6) and subsequent production of acute phase proteins (C-reactive protein, CRP and secretory phospholipase A2, sPLA2) were assessed to investigate whether the HD-induced acute phase reaction depends mainly on the type of membrane or on the sterility of the dialysate. Methods. In 11 patients, IL-6, CRP and sPLA2 levels were assessed in blood samples drawn before (t0), at the end (t180) and 24 h after the start of HD (t1440). All patients were dialysed on Cuprammonium (CU) and Polysulphon (PS) dialysers and seven patients underwent an additional HD session on CU plus a dialysate filter (CUf). Results. IL-6 levels were increased significantly at t180 compared with t0 (Pf. At t1440, IL-6 levels had returned to baseline. In contrast, marked fluctuations did not occur during HD with PS. At t180, IL-6 was significantly greater with CU and CUf devices, than with PS (Pf, a significant increase in CRP was observed at t1440, compared with postdialysis values (P≤0.05). In addition, sPLA2 values were markedly increased at t1440, compared with t180, but only significant in the case of CU (P=0.01). IL-6 levels at t180 were significantly correlated with CRP (r=0.50, P2 (r=0.47, P=0.01) values at t1440. During HD with PS membranes, neither CRP nor sPLA2 values were markedly changed. Conclusions. In contrast to PS, both CU and CUf resulted in elevated IL-6 plasma levels at the end of HD, compared with t0, which correlated with increased CRP and sPLA2 values 24 h later. Therefore, the type of membrane, rather than the bacterial quality of the dialysate, seems to be responsible for the induction of the acute phase response during clinical bicarbonate HD.