Haemodialysis Leucopenia as an Index of Membrane Biocompatibility

Aljama, Pedro; Garín, Jorge M.; Torres, Audrey; Martín‐Malo, Alejandro; Moreno, E.; Pérez-Calderón, Remedios

doi:10.1159/000408562

Cited by 4 publications

(4 citation statements)

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“…Numerous investigators have noted that transient granu locytopenia usually occurs during the initial phase of hemo dialysis with CuM [7][8][9][10]. It has been suggested that this phenomenon most likely results from activation of granulo cytes by the complement-derived fragment C5a activated through the alternative pathway [11], Our results in this study indicate that in vitro, the CuM-induced activation of the alternative pathway is further enhanced by activation through the classical pathway.…”

Section: Capacity O F Cum-activated Sera To Mobilize Mac-1: Effects Omentioning

confidence: 50%

“…The alternative pathway of the complement system is activated during hemodialysis and the extent of complement activation seems to be dependent on the type of membrane used [8]. The peak of complement activation usually occurs at 15 min after initiation of hemodialysis but persists well up to 90 min as shown by a significant difference between con centrations of C3a in the arterial and venous blood lines [9], Leukopenia during hemodialysis is associated with a marked increase in granulocyte adherence [10]. Since granu locyte adherence is increased by the complement system, Craddock et al [11] concluded that dialysis leukopenia is a complement-mediated phenomenon.…”

Section: Introductionmentioning

confidence: 99%

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Dialysis Granulocytopenia Is Preceded by an Increased Surface Expression of the Adhesion-Promoting Glucoprotein Mac-1

Lundahl

Hed²,

Jacobson³

1992

Nephron

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We studied the expression of Mac-1 on granulocytes (flow cytometry) from 9 patients (27 examinations) during hemodialysis with cuprophane membranes (CuM). Samples were drawn before dialysis and from the arterial and venous lines at 5,15 and 180 min. Granulocytopenia was most pronounced after 15 min of treatment. Mac-1 expression on granulocytes increased during dialysis, and a pronounced enhancement occurred across the dialyzer. Mac-1 expression on granulocytes increased 116% across the dialyzer at 5 min, and the degree of Mac-1 mobilization at 5 min correlated with the degree of subsequent granulocytopenia at 15 min. In in vitro experiments, granulocytes from healthy blood donors were incubated with plasma drawn from the arterial and venous lines at 5 min. Plasma drawn from the venous line at 5 min had a greater ability to mobilize Mac-1 than plasma from the arterial line (p < 0.002). This difference correlated with the degree of granulocytopenia at 15 min (r = 0.76, p = 0.01). Pieces of a washed CuM were incubated in normal human serum (NHS) preparations for different times. Inactivation of the alternative pathway of complement activation (NHS-50°) did not alter the generation of Mac-1-mobilizating capacity compared to NHS. In contrast, inactivation of the classical pathway (NHS-EGTA) decreased the early but not the late generation of Mac-1-mobilizating capacity. Our results indicate that the early mobilization and not the absolute expression of Mac-1 correlates with granulocytopenia, and that sera in vitro attain Mac-1-mobilizating capacity more rapidly when the classical pathway of complement activation is intact.

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Section: Capacity O F Cum-activated Sera To Mobilize Mac-1: Effects Omentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Dialysis Granulocytopenia Is Preceded by an Increased Surface Expression of the Adhesion-Promoting Glucoprotein Mac-1

Lundahl

Hed²,

Jacobson³

1992

Nephron

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“…It has been demonstrated that the degree of dialysis-induced leukopenia reflects the extent of the biocompatibility of the dialyzer [16]. In fact, Ivanovich et al [17] reported that there is a relevant clinical correlation between dialysis leukopenia and anaphyla toxin formation with frequency of hemodial ysis intolerance symptoms.…”

Section: Discussionmentioning

confidence: 99%

Anaphylatoxin C5a Generation and Dialysis-Induced Leukopenia with Different Hemodialyzer Membranes

Aljama¹,

Martín‐Malo²,

Castillo³

et al. 1986

Blood Purif

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Leukocyte counts and plasma C5a anaphylatoxin levels were studied during hemodialysis in patients using Cuprophan, polycarbonate and polyacrylonitrile membrane dialyzers. Cuprophan induced a marked leukopenia with significant plasma C5a generation. Polycarbonate promoted the same trend of changes in both parameters but significantly less pronounced, while polyacrylonitrile did not affect leukocyte counts nor plasma C5a levels. These data suggest that complement-derived C5a generation may be an important factor in the mechanism of hemodialysis-induced leukopenia.

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“…Until now membrane biocompatibility has been closely related to quantitative vari ations of leukopenia, complement activation and hypoxia [31]. With regard to leukopenia and complement activation, the new syn thetic membranes of PS and PMMA show a higher biocompatibility than CUP.…”

Section: Studies On the Absorption O F Complement Components By Dialysismentioning

confidence: 99%

Leukocytes, Eosinophils and Complement Function during Hemodialysis with Polysulphone and Polymethylmethacrylate Membranes: Comparison with Cuprophan and Polyacrylonitrile

et al. 1988

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The biocompatibility of the two new dialysis membranes, polysulphone (PS) and polymethylmethacrylate (PMMA), was evaluated versus cuprophan (CUP) and polyacrylonitrile (PAN) by studying the in vivo effects of the four different membranes on leukocyte counts, eosinophil levels and complement function both in the presence and absence of dialysis fluid. Complement function was also examined in vitro by studying the generation of chemotactic factors, whole complement activity and C3d serum conversion. Passive absorption of complement fractions by membranes has completed in vitro studies. PS, PMMA and PAN showed a higher biocompatibility than CUP, even if slight differences can be observed: PS showed a PAN-like biocompatibility pattern with a relatively high absorption of complement factors by the membrane and without complement activation. On the other hand, PMMA showed a CUP-like pattern and caused complement activation, even though to a lower intensity than CUP. PMMA biocompatibility appears to stand in-between CUP and the other two synthetic membranes PS and PAN. Our results confirm the important role played by membrane-induced complement activation on hemodialysis leukopenia. Dialysis fluid does not have a significant influence on membrane biocompatibility, but represents the major factor in determining intradialytic eosinopenia. Eosinophils seem to represent a more important marker of dialysis than of membrane biocompatibility.

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Haemodialysis Leucopenia as an Index of Membrane Biocompatibility

Cited by 4 publications

References 0 publications

Dialysis Granulocytopenia Is Preceded by an Increased Surface Expression of the Adhesion-Promoting Glucoprotein Mac-1

Dialysis Granulocytopenia Is Preceded by an Increased Surface Expression of the Adhesion-Promoting Glucoprotein Mac-1

Anaphylatoxin C5a Generation and Dialysis-Induced Leukopenia with Different Hemodialyzer Membranes

Leukocytes, Eosinophils and Complement Function during Hemodialysis with Polysulphone and Polymethylmethacrylate Membranes: Comparison with Cuprophan and Polyacrylonitrile

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