Effect of Membrane Composition on Cytokine Production and Clinical Symptoms During Hemodialysis: A Crossover Study
Effect of Membrane Composition on Cytokine Production and Clinical Symptoms During Hemodialysis: A Crossover Study
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DOI：
10.1081/jdi-120021154
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发表时间：
2003-01
期刊：
影响因子：
3
通讯作者：
N. Singh;R. Bansal;A. Thakur;R. Kohli;R. Bansal;S. Agarwal
中科院分区：
文献类型：
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作者：
N. Singh;R. Bansal;A. Thakur;R. Kohli;R. Bansal;S. Agarwal
背景。透析过程中有包括低血压在内的透析内症状的报道，有人认为这些症状与血液单个核细胞因与透析膜接触或被补体激活而被激活时释放的细胞因子如IL-1β和TNFα有关。目标。目的：探讨血液透析症状、细胞因子产生与透析膜组成的关系。方法。在一项随机前瞻性交叉研究中，对20名接受维持性血液透析的ESRD患者进行了为期三周的研究，他们分别使用库帕芬（CU）和聚砜（PS）低通量透析器膜，每两周透析4小时。在所有患者首次使用透析器时，分别在0、15、240分钟内测量IL-1β和TNFα水平。在总共240次透析中监测透析内症状。结果。在4小时的透析过程中，CU膜上的IL-1β水平从16.6±2.2增加到64.8±25.1 pg/mL， PS膜上的IL-1β水平从21.5±3.7增加到103.5±30.7 pg/mL。同样，在CU膜上TNFα从42.8±4.5增加到354.9±80.4 pg/mL，在PS膜上从117.1±53.7增加到387.0±78.0 pg/mL。IL-1β水平在PS膜上显著升高，TNFα水平在两种膜上均显著升高。恶心是138次透析中最常见的症状（57.5%）。CU膜透析组呕吐、胸痛、发热、寒战、呼吸困难发生率明显高于PS膜透析组（P<0.01）。恶心、痉挛、背痛、瘙痒、躁动、透析后疲劳和低血压在两种膜之间没有差异。在出现症状的治疗过程的前15分钟，细胞因子水平的平均上升与没有出现症状的治疗过程的平均上升相比，没有显示出任何显著差异。细胞因子释放与体内症状的发生无关。结论。CU和PS膜均可增加循环细胞因子水平。与PS膜透析相比，CU透析中出现更多的透析内临床症状，但细胞因子IL-1β和TNFα的升高似乎不是造成这些症状的原因。
Background. Intradialytic symptoms including hypotension have been reported during dialysis and it has been suggested that these are related to the release of cytokines like IL-1β and TNFα by blood mononuclear cells when they get activated either due to contact with the dialyzer membrane or by compliment activation. Objective. To study the relationship between hemodialysis symptoms, cytokine production, and dialyzer membrane composition. Method. In a randomized prospective crossover study, 20 ESRD patients on maintenance hemodialysis were studied over cuprophan (CU) and polysulfone (PS) low flux dialyzer membranes for three weeks each undergoing a biweekly dialysis schedule of 4 h sessions. Serial IL-1β and TNFα levels were measured over 0, 15, 240 min during the first use of the dialyzer for all patients on both membranes. Intradialytic symptoms were monitored in a total of 240 dialysis sessions. Results. IL-1β levels increased from 16.6 ± 2.2 to 64.8 ± 25.1 pg/mL on CU and 21.5 ± 3.7 to 103.5 ± 30.7 pg/mL on PS membrane over the 4-h dialysis session. Similarly TNFα increased from 42.8 ± 4.5 to 354.9 ± 80.4 pg/mL on CU and 117.1 ± 53.7 to 387.0 ± 78.0 pg/mL on PS membrane. IL-1β levels increased significantly with PS membrane while TNFα rise was significant with both the membranes. Nausea was the most common symptom occurring in 138 dialysis sessions (57.5%). Vomiting, chest pain, fever, chills, and breathlessness occurred significantly more during dialysis with CU membrane as compared with PS membrane (P<0.01). Nausea, cramps, back pain, itching, restlessness, post dialysis fatigue, and hypotension did not differ between the two membranes. The mean rise in the cytokine levels during the first 15 min of sessions where the symptoms occurred, when compared with the mean rise in sessions where the symptoms did not occur, did not reveal any significant difference. Cytokine release did not correlate with the occurrence of intradialytic symptoms. Conclusion. Both CU and PS membranes increase circulating cytokine levels. More intradialytic clinical symptoms are seen in dialysis with CU as compared with PS membrane but the rise in cytokines IL-1β and TNFα does not appear to be responsible for them.