NDT Advance Access originally published online on August 25, 2006
Nephrology Dialysis Transplantation 2006 21(12):3532-3538; doi:10.1093/ndt/gfl415
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Effect of dialysis membrane biocompatibility on polymorphonuclear granulocyte activity in dialysis patients*
1Department of Public Health and Microbiology, University of Turin, Turin and 2Department of Internal Medicine, Nephrology and Dialysis Unit, Civil Hospital, Ivrea, Italy
Correspondence and offprint requests to: Prof. Cuffini Anna Maria, Department of Public Health and Microbiology, Microbiology Section, University of Turin, Via Santena 9, 10126 Turin, Italy. Email: annamaria.cuffini{at}unito.it
Background. Among patients with defects of the phagocytic component of the immune system, chronic haemodialysis patients are highly susceptible to microbial infections characterized by high morbidity/mortality, related to an impairment of the phagocytic response. Therefore the potential influence of dialysis membrane biocompatibility on the activity of polymorphonuclear (PMN) granulocytes from dialysis patients was investigated in this study.
Methods. Nineteen patients in haemodialysis were included in the protocol and divided into two groups: a control group (7 patients) and a study group (12 patients). The study group patients were treated for subsequent periods of 1 month with different dialysis membranes: low flux excebrane E membrane (CL-E), low flux polysulfone (PS). The control group patients were treated with a low flux modified cellulose membrane (SMC) for the entire observation period.
The aetiology of end-stage renal disease included glomerulonephritis, nephroangiosclerosis and interstitial nephropathy. Following each period of treatment, clinical and haematological parameters were evaluated; phagocytosis and microbicidal activity of PMNs from uraemic patients against Klebsiella pneumoniae, the pathogen which can pose severe problems in immune depressed patients, were investigated in parallel.
Results. The data evidence that both clinical and haematological parameters remained unchanged during the study period and no differences were found among treatments. On the contrary, the PMN activity varied according to the type of the membrane. In fact, the use of both PS and CL-E, in contrast to SMC, resulted in a PMN functionality similar to that observed in healthy subjects.
Conclusions. These results provide evidence that the depressed PMN activities in dialysis patients may be influenced by membrane biocompatibility in such a way to be totally restored.
Keywords: chronic renal insufficiency; dialysis membrane; human polymorphonuclear cells; intracellular killing; Klebsiella pneumoniae; phagocytosis
* This study was presented in part at the ASN meeting, October 27–November 1 2004, St Louis, MO, USA.