EFFECT OF HEMODIALYSIS ON THE HOST IMMUNE SYSTEM

抄録

The effect of hemodialysis (HD) using the cuproammonium processing membrane (CAPM) on the host immune system was studied in maintenance HD patients. Plasma C3a and C5a concentrations at the inlet and outlet of the dialyzer were measured during HD. Anaphylatoxins such as C3a and C5a were generated in the blood through the CAPM dialyzer, and the amount of anaphylatoxins generated correlated with membrane area. The effect of the Limulus test-positive substance, which was assumed to be β-glucan, on interleukin-1 (IL-1) and β2-microglobulin (β2-M) production activity of peripheral blood monocytes from HD patients on the CAPM and polymethylmetacrylate membrane (PMMA) dialyzers was also studied. IL-1 was bioassayed using C3H/HeJ mouse thymocytes. β2-M was radioimmunoassayed. IL-1 production activity of the monocytes from patients on CAPM was significantly higher than that of patients on PMMA and healthy volunteers. Moreover, β-glucan stimulated IL-1 production activity of the monocytes. However, inactivated serum from long-term HD patients inhibited IL-1 production activity induced by LPS and β-glucan. The washing solution obtained from the CAPM dialyzer and β-glucan stimulated β2-M production activity of the monocytes in vitro and in vivo. β2-M production activity of the monocytes from HD patients was significantly lower compared to that of healthy volunteers, but it was significantly higher for patients on CAPM than for those on PMMA. The intravenous injection of the washing solution from the CAPM dialyzer also increased β2-M concentration in the monocytes for all groups, but it was significantly higher for healthy volunteers than for patients on CAPM and PMMA. These findings suggest that bio-incompatibility of the dialyzer membranes and eluted material lead to not only intradialytic symptoms but also chronic inflammatory syndrome.