Cytokine Production in Haemodialysis

Memoli, Bruno

doi:10.1159/000014387

Cited by 40 publications

(21 citation statements)

References 88 publications

(101 reference statements)

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“…Although the 'earlystart hypothesis' may seem attractive it could not be ruled out that the dialysis procedure actually might aggravate systemic inflammation as available evidence from crosssectional studies suggests that the prevalence of elevated CRP is higher in HD than predialysis patients (table 1). Although the occurrence of pyrogenic reactions due to passage of endotoxins, or endotoxin fragments, has decreased in the recent years, monocyte activation with subsequent cytokine production may still take place during the dialysis procedure [83]. Haubitz et al [84] have demonstrated that acute-phase proteins are induced during HD, probably due to cytokine release, and according to Schindler et al [85] the dialyser membrane may play a role in the induction of an inflammatory reaction during the dialysis procedure.…”

Section: Does the Dialysis Procedures Per Se Accelerate The Atherosclementioning

confidence: 99%

Inflammatory and Atherosclerotic Interactions in the Depleted Uremic Patient

2000

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Despite the improvements in dialysis technology, the cardiovascular mortality rate is still unacceptably high among dialysis patients. It is obvious that traditional risk factors, such as hypertension, chronic heart failure (CHF), dyslipidemia and diabetes mellitus, may account for a large part of the increased cardiovascular mortality rate in these patients. However, based on recent research it could be speculated that other, non-traditional risk factors might also contribute to the high cardiovascular mortality rate in dialysis patients. Chronic inflammation, as evidenced by increased levels of pro-inflammatory cytokines and C-reactive protein (CRP), is a common feature in dialysis patients and is associated with an increased cardiovascular morbidity and mortality. Indeed, elevated levels of pro-inflammatory cytokines (such as TNF-α, IL-1 and IL-6) may cause malnutrition and progressive atherosclerotic cardiovascular disease by several pathogenetic mechanisms, which will be discussed in this review. Based on the strong associations observed between malnutrition, inflammation and atherosclerosis in patients with chronic renal failure (CRF) we have proposed that these features constitute a specific syndrome (MIA), which carries a high mortality rate. As elevated levels of pro-inflammatory cytokines may play a central part in the vicious circle of malnutrition, inflammation and atherosclerosis, further research is needed to investigate whether or not different anti-cytokine treatment strategies may improve survival in dialysis patients.

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Section: Does the Dialysis Procedures Per Se Accelerate The Atherosclementioning

confidence: 99%

Inflammatory and Atherosclerotic Interactions in the Depleted Uremic Patient

2000

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“…Patients who underwent hemodialysis (HD) were also in a state of chronic infl ammation [7][8][9] . Recently, we found that serum levels of IL-18 were higher in dialysis patients and were associated with poor outcome.…”

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confidence: 99%

Plasma Interleukin-18 Levels in Hemodialysis Patients: Increased by Dialysis Process and Association with Interleukin-6 and Tumor Necrotic Factor-α

et al. 2006

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Background/Aims: This study investigated changes of interleukin-18 (IL-18) levels before and after dialysis, and the possible association with other pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Methods: Plasma IL-18 of healthy controls, and pre- and post-dialysis of uremic patients undergoing hemodialysis (HD) were evaluated by ELISA methodology. Results: Plasma IL-18 levels were significantly increased in patients with maintenance HD (p <0.001) compared to its level in normal subjects. When compared to pre-dialysis levels, a significant increase in plasma IL-18 was measured at the end of HD (p = 0.032). There was a significant correlation among plasma IL-18, IL-6 and TNF-α levels in HD patients. Conclusion: Plasma IL-18 concentration was significantly higher in HD patients and was significantly elevated by cellulose-based HD processes. Pre-activation of immunologically active cells may contribute to the association between pre-dialysis IL-18 and post-dialysis IL-6 and TNF-α levels.

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“…It has been suggested that some dialysis-related alteration in the immune and host-defense system may be relevant, as they seem to correlate to the high production of proinflammatory cytokines (8). Moreover, the type of dialysis membrane has been suggested to play a role (9) as well as time on dialysis, as it correlated negatively with cytokine release (10).…”

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confidence: 99%

Effect of an Increase in C-Reactive Protein Level during a Hemodialysis Session on Mortality

Korevaar¹,

Manen

Dekker

et al. 2004

Journal of the American Society of Nephrology

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Abstract. The prevalence of chronic inflammation is high in dialysis patients. Moreover, it is associated with an increased mortality risk, yet the origin of chronic inflammation in dialysis patients remains unclear. The aim of this study was to determine the effect of a hemodialysis session (HD) on C-reactive protein (CRP) levels and to study the relation with survival. As part of a large, prospective, multicenter study in the Netherlands (Netherlands Cooperative Study on the Adequacy of Dialysis), patients who were started on dialysis treatment between September 1997 and May 1999 were included. Demographic data, clinical data, and serum samples were collected at regularly timed intervals. From this cohort, a random sample of patients was taken. CRP levels were determined before and after an HD session and before the next session. Date of death or censoring was recorded until September 2002. A total of 186 HD patients were included. Mean age was 65 yr (SD, 13); 56% were male. A total of 71 patients had a CRP level below the detection limit (3 mg/L), 68 patients showed no increase in CRP during an HD session (no-increase group), and 47 (25%) patients showed an increase in CRP level during an HD session (increase-group). No statistically difference in mean CRP levels before the dialysis session was found between the increase group (22.3 mg/L) and the no-increase group (19.4 mg/L). In the subsequent interdialytic period, CRP levels returned to the levels of the initial CRP value. Two-year survival was 44% in the increase group and 66% in the noincrease group (P ϭ 0.09). Independent of CRP level before the session and adjusted for age, comorbidity, nutritional status, and primary kidney disease, a raise of 1 mg/L CRP during a session was associated with a 9% increased mortality risk (adjusted hazard ratio, 1.09; 95% CI, 1.02 to 1.16). The present study showed an increase in CRP level during a single dialysis session in 25% of the patients; during the succeeding interdialytic period, CRP level returned to its original value. More important, however, an increase in CRP level during an HD session was independently associated with a higher mortality risk.

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Cytokine Production in Haemodialysis

Cited by 40 publications

References 88 publications

Inflammatory and Atherosclerotic Interactions in the Depleted Uremic Patient

Inflammatory and Atherosclerotic Interactions in the Depleted Uremic Patient

Plasma Interleukin-18 Levels in Hemodialysis Patients: Increased by Dialysis Process and Association with Interleukin-6 and Tumor Necrotic Factor-α

Effect of an Increase in C-Reactive Protein Level during a Hemodialysis Session on Mortality

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