Elevated levels of tumor necrosis factor alpha in postdialysis fatigue

Abstract

Postdialysis fatigue (PDF) has been ascribed to excessive ultrafiltration and decline in osmolality during hemodialysis. We evaluated the potential role for the sommogenic cytokines, interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNFα), in the genesis of PDF. Patients dialyzing with cuprophane membrane were assigned to PDF (N=25) and non-PDF (N=25) groups based on a fatigue index questionnaire. Pre- and postdialysis samples were obtained from 3 consecutive treatments and later assayed for serum levels of IL-1β and TNFα by ELISA. Our results show significant intradialytic elevation of TNFα in both non-PDF groups (non-PDF: pre- 3.36±0.80 pg/ml to post 3.75±0.88 pg/ml, p<0.04; PDF: pre- 5.95±0.80 pg/ml to post- 8.66±1.35 pg/ml, p<0.02). The degree of intradialytic augmentation was significantly greater for TNFα in the PDF group (46 ± 18% vs 11 ± 5%; p<0.03). There were no significant intradialytic changes in serum levels of IL-1β in either the PDF or non-PDF groups. There also were no significant differences in dialysis-related body weights, systolic blood pressures, or osmolalities. These findings suggest that TNFα may be involved in the pathogenesis of PDF. (Int J Artif Organs 1998; 21:83–6)

Use of Proton Pump Inhibitors Is Not Associated with Post-Dialysis Fatigue and Time of Recovery after Dialysis in Patients on Maintenance Hemodialysis

“…The causes and the pathogenesis of PDF are essentially unknown [ 1 , 2 , 3 , 4 ]. However, some mechanisms have been proposed, such as the rapid decline in osmolarity occurring during dialysis as result of the combined effect of a reduction in serum urea and sodium concentration (this leads to brain swelling and headache, restlessness, nausea, muscle cramps and fatigue [ 5 , 6 ]; the release of cytokines such as interleukin-1, interleukin-6 and tumor necrosis factor-alpha [ 7 , 8 , 9 ]; the accumulation of metabolites and toxins in the muscle [ 10 ]).…”