Is dialysis membrane type responsible for increased circulating adhesion molecules during chronic hemodialysis?

C. Mrowka et al., Is dialysis membrane type responsible for increased circulating adhesion molecules during chronic hemodialysis?, CLIN NEPHR, 52(5), 1999, pp. 312-321
Citations number
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
ISSN journal
0301-0430 → ACNP
Year of publication
312 - 321
SICI code
Background: Patients with chronic renal failure under maintenance hemodialy sis (HD) present with numerous adverse effects including immunologic altera tions. Serious abnormalities of neutrophil function have been reported to b e associated with disturbed cell adhesiveness. These adhesion processes are mediated by cytokines and different adhesion molecules. Patients and metho ds: In this study, serum concentrations of the intercellular adhesion molec ule ICAM-1, vascular cell adhesion molecule VCAM-1 and endothelial leukocyt e adhesion molecule E-selectin were investigated during employment of diffe rent dialysis membranes (cuprophane: n = 23, cellulose: 8, polysulfone: 26, acrylonitrile: 7). These adhesion parameters from 64 patients before and a fter a hemodialysis session were investigated parallel to the serum levels of circulating cytokines and their inhibitors. Results: Circulating ICAM-1 levels were not elevated in low-flux membranes and most of the high-flux HD membranes, except for one high-flux polysulfone membrane, cVCAM-1 levels w ere significantly elevated both in low- and high-flux dialysis membranes, w hereas cE-selectin was not increased. cICAM-1 levels were not different bef ore and after hemodialysis in the entire study group. In contrast, cVCAM-1 and cE-selectin levels increased significantly during HD in the entire stud y group (both p < 0.001). Serum levels did not correlate with the duration of end-stage renal failure and hemodialysis. Levels of circulating cytokine antagonists/inhibitors (Il-1ra, Il-2R, TNFsRp55/75) were significantly inc reased in all patients before and after KD, whereas the serum concentration s of the corresponding circulating cytokines (Il-1 beta, Il-1, TNF-alpha) w ere within normal ranges. Conclusion: Increased levels of cVCAM-1 which sug gest an important role for immunological alterations in HD and cytokine-ind ependent changes during HD sessions in all membranes without alterations of cICAM-1 in most membranes and unchanged cE-selectin indicate that processe s such as uremia are responsible for these effects rather than membrane cha racteristics. The level of circulating adhesion molecules does not serve as an appropriate marker of membrane biocompatibility.