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      Leukocyte, Platelet and Endothelial Activation in Patients with Acute Renal Failure Treated by Intermittent Hemodialysis

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          Abstract

          Background: Using different types of dialysis membranes to treat acute renal failure (ARF), clinical and experimental studies have demonstrated discordant results relatively to the effect of membrane bioincompatibility on patient outcome. Nevertheless, there are few data on the biocompatibility indices in patients with ARF who need to be treated by hemodialysis. Objective: To characterize the impact of intermittent hemodialysis (IHD) on indices of leukocyte, platelet and endothelial activation in patients with ARF. Patients and Methods: We prospectively studied 27 patients with severe ARF treated by IHD. They were characterized relatively to gender, age, ARF etiology, urinary output per 24 h, Simplified Acute Physiology Score (SAPS), number of dialysis sessions and outcome. We evaluated the effect of hemodialysis with two types of low-flux dialyzers (cuprophane and polysulfone dialyzers) on plasma concentrations of soluble TNF-RI (TNF-sR55), TNF-RII (TNF-sR75), interleukin (IL)-6, soluble CD23 molecule, soluble P-selectin and von Willebrand factor (vWF). Results: There were no significant differences between the two groups of patients dialyzed with cellulose-based and synthetic membranes in terms of age, sex, urinary output per 24 h, SAPS, number of dialysis sessions and mortality. We verified high plasma concentrations of TNF-sR55, TNF-sR75, IL-6, sCD23, sP-selectin and vWF in the global population studied. Patients dialyzed with cuprophane membranes showed significantly lower pre- and postdialysis concentrations of sP-selectin than patients dialyzed with polysulfone membranes. After a hemodialysis session, with correction for differences of blood hematocrit, we did not observe any significant modification in the concentrations of TNF-sR55, TNF-sR75, IL-6, sP-selectin and vWF of the plasma. On the other hand, a significant increase of sCD23 molecule was found in the group dialyzed with polysulfone membranes (p = 0.009). Conclusions: The group of 27 patients with ARF who needed IHD, showed increased plasma concentrations of some leukocyte, platelet and endothelial activation markers (TNF-sR55, TNF-sR75, IL-6, sCD23, sP-selectin and vWF). These mediators characterize the inflammatory and procoagulant state associated with this pathologic condition. After a hemodialysis session with these low-flux membranes (cellulose-based and polysulfone membranes), we did not observe any significant variation in the concentrations of TNF-sR55, TNF-sR75, IL-6, sP-selectin and vWF of the plasma. Patients dialyzed with polysulfone membranes presented higher basal plasma concentrations of sP-selectin and significant postdialysis increase of plasma concentrations of CD23 molecule compared to patients dialyzed with cuprophane dialyzers.

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          Most cited references 4

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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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              Haemodialysis-membrane biocompatibility and mortality of patients with dialysis-dependent acute renal failure: a prospective randomised multicentre trial

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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2001
                August 2001
                13 August 2001
                : 21
                : 4
                : 264-273
                Affiliations
                aNephrology Department, Hospitais da Universidade de Coimbra and bImmunology Center, Medicine Faculty of Coimbra University, Coimbra, Portugal
                Article
                46260 Am J Nephrol 2001;21:264–273
                10.1159/000046260
                11509797
                © 2001 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 6, Tables: 5, References: 43, Pages: 10
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/46260
                Categories
                Clinical Study

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