Nephrology Dialysis Transplantation, Vol 12, Issue 7 1387-1393, Copyright © 1997 by Oxford University Press
JC Bos, MP Grooteman, AJ van Houte, M Schoorl, J van Limbeek and MJ Nube
INTRODUCTION: Haemodialysis (HD)-induced bio-incompatibility includes
alterations in both cellular elements and humoral factors. As far as
polymorphonuclear (PMN) cells are concerned, an increase in both adhesion
and degranulation has been reported. However, whereas increased PMN
adherence and aggregation is highly linked with early transient complement
activation, degranulation seems a continuous process, independent from the
formation of complement degradation products. In the process of cell
activation, including PMN degranulation, divalent cations (Ca2+) appear to
play a pivotal role. As regionally administering citrate creates an almost
Ca(2+)-free environment within the dialyser, it is tempting to speculate
that Ca2+ dependent phenomena of bio-incompatibility, originating within
the dialyser, can be attenuated by substituting conventional heparin for
citrate. METHODS: Therefore, both anticoagulation modalities were compared
in 10 stable patients, undergoing haemodialysis (HD) treatment with
cellulose-triacetate membranes (CTA) only. Apart from the intracellular
granule products myeloperoxidase (MPO) and lactoferrin (LF), the classical
parameters of bio-incompatibility, peripheral blood neutropenia and
complement activation, were measured. RESULTS: Analysis of MPO and LF
gradients across the dialyser (concentration in efferent line-concentration
in afferent line) suggested that degranulation is an early process, that
occurs mainly within the extracorporeal circuit. Citrate abolished the
release of MPO almost completely, whereas LF release was partially
inhibited. Neither neutropenia, nor complement activation could be
correlated with the occurrence of degranulation. CONCLUSIONS: HD-induced
PMN degranulation seems largely independent from complement activation, but
primarily reliant on Ca2+, at least in the case of CTA membranes.
ORIGINAL ARTICLES
Low polymorphonuclear cell degranulation during citrate anticoagulation: a comparison between citrate and heparin dialysis
Department of Nephrology, Medical Centre Alkmaar, The Netherlands.
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