cellulose-triacetate and Inflammation

To compare small, middle and large-middle molecule clearance; and expression of markers of inflammation, between Solacea-190H (asymmetric cellulose triacetate [ATA]) and FX-80 dialysers in long-hour haemodialysis patients.. This pilot, randomized cross-over trial recruited 10 home haemodialysis patients. The total study duration was 8 weeks, using each dialyser for 4 weeks. Removal of small (urea, phosphate, creatinine and indoxyl sulfate [IS]), middle and large-middle molecules (beta-2 microglobulin [β2M], albumin), markers of inflammation (interleukin-6 [IL-6], malondialdehyde-modified low density lipoprotein [MDA-LDL] and alpha-1 microglobulin [α1M]), was evaluated in serum and dialysate samples.. Reduction ratios [RR] were calculated for variables at the fourth week of each dialyzer sequence and results expressed as difference in mean RR between dialyzers. There was no difference in clearance of small molecules, with difference in mean RR for urea -2.43 (95% CI -6.44, 1.57; p = .19), creatinine -1.82 (95% CI -5.50, 1.85; p = .28) and phosphate -2.61 (95% CI -12.45, 7.23; p = .55); clearance of middle and large-middle molecules with difference in mean RR (range) for β2M 2.2 (95% CI -3.2, 7.7; p = .35), IS 1.8 (95% CI -9.5, 13; p = .72) and albumin -0.6 (95% CI -5.5, 4.2; p = .77). There was lack of induction of markers of inflammation, including IL-6 15.2 (95% CI -31.9, 62.2; p = .47), MDA-LDL -8.1 (95% CI -22.1, 5.8; p = .21) and α1M -3.50 (95% CI -29.2, 22.2; p = .76). Dialysate removal results were concurrent.. This study showed no difference in clearance of small, middle and large-middle molecules, nor expression of markers of inflammation between dialysers.

Topics: Albumins; beta 2-Microglobulin; Cellulose; Creatinine; Dialysis Solutions; Fluorocarbons; Furans; Humans; Inflammation; Interleukin-6; Membranes, Artificial; Phosphates; Pilot Projects; Polymers; Renal Dialysis; Sulfones; Urea

During hemodialysis (HD), blood-membrane interactions lead to activation of several circulating cells and plasma proteins. The resultant activation and/or release of mediators can modulate the structure, function and survival of circulating neutrophils. Little is known of plasma factors that influence apoptosis of neutrophils in hemodialyzed patients. Hence, we investigated the effect of uremic plasma obtained during HD on the survival of neutrophils obtained from healthy volunteers. Neutrophils harvested from healthy volunteers were incubated in ultrafiltered culture medium supplemented with either 50% heterologous normal plasma obtained from healthy volunteers (n = 15) or 50% uremic plasma collected from long-term HD patients dialyzed with cuprophan (CU) (n = 8), cellulose triacetate (CTA) (n = 8) or polysulfone (PS) (n = 8) dialyzers. Plasma samples were drawn predialysis, 15 min after starting dialysis, and postdialysis. After 24-hour incubation, neutrophil aliquots were processed for quantification of apoptosis by flow cytometry, using propidium iodide DNA staining. In addition, tumor necrosis factor alpha (TNFalpha) and interleukin-10 (IL-10) were measured in normal and predialysis uremic plasma samples. Neutrophils from healthy volunteers exposed to heterologous normal plasma samples exhibited 10.3 +/- 1.2% apoptosis. In contrast, the proportion of apoptosis was significantly higher among neutrophils exposed to predialysis (28.5 +/- 2.3%, p < 0.0001), 15 min (23.0 +/- 2.4%, p < 0.0001), or postdialysis uremic plasma samples (25.7 +/- 2. 3%, p < 0.0001). Compared to neutrophils exposed to predialysis uremic plasma samples, a significantly lower proportion of apoptosis was observed in neutrophils exposed to the 15-min plasma samples among patients dialyzed with CU (26.4 +/- 2.9 vs. 18.2 +/- 3.5%; p < 0.001) but not with CTA or PS dialyzers. Further, CU membranes induced the greatest percentage decrease in neutrophil apoptosis at 15 min. There was a direct correlation between neutrophil apoptosis and plasma levels of TNFalpha (r = 0.424, p = 0.02) and IL-10 (r = 0. 744, p < 0.0001). The results of the study suggest that normal neutrophils exposed to uremic plasma undergo accelerated in vitro apoptosis compared to those incubated with normal plasma. Further, during HD, the apoptosis-inducing activity of uremic plasma is modulated by the use of dialyzers with different degrees of biocompatibility. The identification of soluble factors that are responsib

Topics: Adult; Aged; Aged, 80 and over; Apoptosis; Cells, Cultured; Cellulose; Chemotaxis, Leukocyte; Complement C5a; Complement Pathway, Alternative; Female; Humans; Inflammation; Interleukin-10; Male; Membranes, Artificial; Middle Aged; Neutrophils; Polymers; Renal Dialysis; Respiratory Burst; Sulfones; Tumor Necrosis Factor-alpha; Uremia

Clinical and experimental evidence suggest that haemodialysis (HD) procedure is an inflammatory process. For the production of proinflammatory lipid mediators in many inflammatory reactions, the release of arachidonic acid by phospholipase A2 (PLA2) enzyme is a prerequisite. Therefore, the purpose of the present investigation was to establish whether the activity of PLA2 increases during HD and whether the increase depends on the type of dialyser used.. We performed dialysis in eight chronic HD patients. Blood samples entering and leaving the dialyser were obtained before and at 15, 60, 120 and 180 min after the dialysis was started, on one occasion using a cuprophane and on another occasion a cellulose triacetate dialyser. PLA2 activity was assessed in crude plasma and in plasma extract.. PLA2 activity in plasma extract exhibited similar biochemical properties to that of inflammatory human synovial fluid PLA2 enzyme which is of group II PLA2. PLA2 activity in crude plasma represents a type of PLA2 other than the synovial type. In HD patients, baseline PLA2 activities in a crude plasma and plasma extract were significantly increased when compared to normal subjects. An increase in PLA2 activity was observed in crude plasma with a peak appearing at 15 min when the patients were dialysed with cuprophane and cellulose triacetate membranes. This increase was observed in both arterial and venous blood samples and was more pronounced when the patients were dialysed with cuprophane than with cellulose triacetate membranes. When PLA2 was assessed in plasma extract, the activity increased only with cuprophane but not with cellulose triacetate membranes.. PLA2 activity in plasma is increased in HD patients and increases during the dialysis procedure to a greater extent with a less biocompatible membrane. Continuous activation of PLA2 might be relevant for long-term deleterious consequences of HD.

Topics: Adult; Aged; Arachidonic Acid; Biocompatible Materials; Biomarkers; Cellulose; Enzyme Activation; Female; Humans; Hydrogen-Ion Concentration; Inflammation; Male; Membranes, Artificial; Middle Aged; Phospholipases A; Phospholipases A2; Renal Dialysis