Nephrology Dialysis Transplantation, Vol 13, Issue 7 1737-1744, Copyright © 1998 by Oxford University Press
V Panichi, S De Pietro, B Andreini, M Migliori, V Tessore, D Taccola, P Rindi, R Palla and C Tetta
Background: Bacterial contamination of dialysate may
enhance cytokine production in haemodialysis. We tested the hypothesis that
intracellular cytokines could be enhanced in a large group of patients
exposed to backfiltration of dialysate over a long period of observation.
Methods: The intracellular cytokine (interleukin-1
receptor antagonist and interleukin-1{beta}) concentrations in chronic
uraemic patients undergoing haemodiafiltration, which is known to be
associated with backfiltration (Group II, 12 patients), were compared to
those found in patients treated with a modified haemodiafiltration modality
without backfiltration (group I, 16 patients), in patients shifted from one
modality to the other (Group III, 27 patients) and in 10 patients on
haemodialysis (Group IV) in a 1-year multicentre study. Group V comprised
10 healthy volunteers. All dialysis monitors were equipped with dialysate
ultrafiltration systems. Dialysate contamination was studied by the LAL and
the peripheral mononuclear cell/interleukin-1{beta} assays in the
presence or absence of polymyxin B. Results:
Intracellular interleukin-1 receptor antagonist and interleukin-1{beta}
both increased significantly (P<0.002) but slowly (after 8 months)
in Groups II vs I, and during the 4-month period in
haemodiafiltration with backfiltration in Group III. The incidence of
post-predialysis concentration ratio (over 1.5) increased two- to threefold
in patients treated with heaemodiafiltration with backfiltration with
respect to haemodiafiltration without backfiltration. Results on the assays
for LAL (<0.5 E/ml) and interleukin-1{beta} (range 80.1-90.2
pg/5x106 cells; 70.2-81.3
pg/5x106 cells with polymyxin B) showed a
moderate-to-low degree of dialysate contamination.
Conclusions: Backfiltration of dialysate with
moderate-to-low degree of contamination may enhance cytokine synthesis in
the long term. Thus, the relevance for dialytic strategies aiming at
improving dialysate quality and/or at reducing backfiltration is
highlighted. Key words: backfiltration;
biocompatibility; dialysate sterility; haemodialysis membranes;
haemodialysis (chronic complications)
ORIGINAL ARTICLES
Cytokine production in haemodiafiltration: a multicentre study
Internal Medicine, University of Pisa, Italy; Department of Nephrology and Dialysis, Santa Chiara Hospital, Pisa, Italy; Clinical and Laboratory Research Department, Bellco S. p. A., Via Camurana 1/A, I-41037 Mirandola (Modena), Italy; Corresponding author
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