Abstract
Severe transient leukopenia in patients undergoing dialysis (HD) with cellulosic membrane (Cell) and, in contrast to it, very mild leukopenia with poly (methyl methacrylate) membrane (PMMA) have often been reported. On the other hand, decrease in complaints on HD-related symptoms from patients has been suggested on transfer from HD with Cell to that with PMMA.
In order to clarify the probable correlation between biocompatibility of membranes and clinical conditions of patients, following three evaluations were carried out.
1) Seven patients were pairwisely dialyzed with PMMA and Cell, and the hemograms during these treatments were observed.
2) Complement activation especially through the alternative pathway was measured on serum incubated with PMMA and Cell by immunoelectrophoresis.
3) Clinical parameters routinely measured in 19 patients who were switched from HD with Cell to that with PMMA were analyzed and statistical significance of their change was tested.
As already reported, significant difference (P<0.01) was observed on the extent of leukopenia between PMMA and Cell at 15min. from the beginning of HD. In addition, as to the subpopulation of neutrophil, significantly greater left shift (P<0.05) was observed in HD with Cell at 30min. from its start than that with PMMA. In the latter half of HD with Cell, total count of metamyelocyte and stab neutrophil remarkably increased, which might mean the release of immature neutrophils from bone-marrow.
Distinct activation of complement C3 was demonstrated with Cell but scarcely with PMMA.
Among clinical parameters in 19 patients who were switched from HD with Cell to that with PMMA, significant and interesting decrease in pre- and post-HD body weight was detected.
Our observations thus consisted with proposed correlation between leukopenia and complement activation.
It is not easy to pinpoint the true cause of this decrease in body weight accompanied with change of membranes, but it can be hypothesized that complement activation is correlated with drop in body weight through HD-related symptoms and patient tolerance. This hypothesis will be studied in more details.
