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      Biocompatibility Parameters of Different Dialysis Membranes Assessed during Systemic Inflammation

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          Background: We explored whether biocompatible dialyzer membranes modulate the inflammatory response during blood contact in patients with systemic inflammation. Methods: 15 patients with end-stage renal disease and systemic inflammation (mean serum C-reactive protein 86 ± 4 mg/l) were randomly treated with Cuprophan (CU), polyamide (PA) and vitamin-E coated (VEC) membrane-based dialyzers. Results: Changes in blood pressure, capillary blood oxygen saturation and differential blood counts during the hemodialysis session were not significantly different between the three dialyzers. Baseline blood levels of activated circulating complement (C3a) were more than 100 times above normal, and unlike expected they decreased during hemodialysis treatments (CU: from 7,389 ± 783 to 5,423 ± 761 ng/ml; PA: from 7,379 ± 980 to 5,690 ± 714 ng/ml; VEC: from 7.377 ± 714 to 5,360 ± 1,005 ng/ml; all n.s.). No significant differences between treatments were found with respect to changes in blood concentrations of TNF-α, interleukin-6 and interleukin-1 receptor antagonist as well as ICAM-1 (CU: from 451 ± 41 to 477 ± 41 ng/ml; PA: from 437 ± 42 to 449 ± 40 ng/ml; VEC: from 461 ± 43 to 460 ± 47 ng/ml). Furthermore, generation of reactive oxygen species by mononuclear blood cells was comparable during hemodialysis with the CU, PA and VEC dialyzer. Conclusion: The choice of dialyzer membrane material does not affect most aspects of biocompatibility when patients have significant systemic inflammation. This confounding variable should be taken into account in studies exploring the effects of biocompatible dialyzer membranes.

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          Effect of the dialysis membrane in the treatment of patients with acute renal failure.

          The mortality rate among patients with acute renal failure remains high, and the role of the biocompatibility of the dialysis membrane in the resolution of this disorder is not known. We prospectively studied 72 patients with acute renal failure who required hemodialysis and assigned them to two treatment groups. One group underwent dialysis with the widely used cuprophane dialysis membrane, which activates the complement system and leukocytes, and the other group underwent dialysis with a synthetic polymethyl methacrylate membrane, which has a more limited effect on complement and leukocytes. Scores on the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) were calculated at the initiation of dialysis. Survival and the recovery of renal function were determined with the use of proportional-hazards and exact logistic-regression analyses. When dialysis was initiated, the patients in the two groups were similar in terms of age, APACHE II scores, the prevalence of oliguria, and biochemical indexes of renal failure. Twenty-three of the 37 patients (62 percent) in the group undergoing dialysis with the polymethyl methacrylate membrane recovered renal function, as compared with 13 of the 35 patients (37 percent) in the group undergoing dialysis with the cuprophane membrane (P = 0.04 after adjustment for the APACHE II score). The median number of dialysis treatments required before the recovery of renal function was 5 in the former group and 17 in the latter group (P = 0.02). Twenty-one patients (57 percent) undergoing dialysis with the polymethyl methacrylate membrane survived, as compared with 13 patients (37 percent) undergoing dialysis with the cuprophane membrane (P = 0.11). Of the 20 patients in each group who initially had nonoliguric acute renal failure, the survival rates were 80 percent with the polymethyl methacrylate membrane and 40 percent with the cuprophane membrane (P = 0.01). Among patients with acute renal failure requiring hemodialysis, the use of the polymethyl methacrylate membrane, as compared with the cuprophane membrane, resulted in improved recovery of renal function.
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            Biocompatible membranes in acute renal failure: prospective case-controlled study

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              Intercurrent clinical events are predictive of plasma C-reactive protein levels in hemodialysis patients.

              In chronic hemodialysis (HD) patients, the repetitive induction of the acute phase response (APR) may induce a chronic micro-inflammatory state, leading to various long-term complications. The present prospective study was designed to assess the alterations in the APR in 74 patients who were randomized to HD with a high-flux polysulfone (PS; F 60S), a super-flux PS (F 500S), or a super-flux cellulosic tri-acetate (CTA and CTA with filtered dialysate, CTA(f)) dialyzer. Blood samples collected at the start of the study and after twelve weeks were analyzed for interleukin-6 (IL-6) and C-reactive protein (CRP). In addition to the microbiological quality of the dialysate, the appearance of a "clinical event" was assessed. At baseline, mean IL-6 levels were within the reference range whereas mean CRP levels were slightly elevated. Mean values did not change after 12 weeks of HD with either modality. After subdividing the patients in quartiles with increasing change in plasma CRP, 23.0% of the patients showed a change of more than 8.0 mg/L. In a multiple regression analysis, CRP levels appeared to be independent of the degree of dialysate contamination, the material and the flux characteristics of the devices. In fact, the variable "clinical events" was the only significant predictor of the plasma CRP levels (P < 0.001). Based on these results, both PS and CTA super-flux dialyzers appear safe for clinical use. Whether changes in CRP values, which are associated with intercurrent clinical events, influence the long-term prognosis of chronic HD patients remains to be established.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                May 2005
                19 May 2005
                : 23
                : 3
                : 196-202
                Departments of aInternal Medicine, bPharmacology and cMedical Microbiology, Medical School Hannover, Hannover, Germany
                83941 Blood Purif 2005;23:196–202
                © 2005 S. Karger AG, Basel

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                Page count
                Figures: 5, Tables: 2, References: 23, Pages: 7
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                Original Paper

                Cardiovascular Medicine, Nephrology

                Polyamide, Biocompatibility, Vitamin E, Inflammation, Cuprophan


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