Effect of vitamin E modified cellulose membrane on human lymphocyte, monocyte, and granulocyte CD11b/CD18 adhesion molecule expression during hemodialysis.

Chronic renal failure induces a clinical state of immunodefi ciency that also depends upon a wide spectrum of dialysis membranes used during hemodialysis. Previous studies have shown that cellular immunodeficiency is caused by malfunc tion of the antigen presenting cells (monocytes or granulocytes). Subsequent activation of rolling mononuclear leuko cytes results in up-regulated expression of CD11b/CD18 (Mac-1) on endothelial cells. It is postulated that a VitE coated dialysis membrane might minimize the membrane biocompatibility, thereby generating a smaller amount of re active oxygen species (ROS). The purpose of this study was to evaluate the expression of the CD11b/CD18 adhesion mole cule on lymphocytes, monocytes, and granulocytes during HD in 10 patients, using flow cytometric analysis. The study protocol included the measurement of molecule expression using cellulose membrane (Clirans RS15, TERUMO Corp. Japan), and the same membrane coated by vitamin E (Exce brane, Clirans E15, TERUMO Corp., Japan) during 20 dialysi sessions each. Lymphocyte CD11 b/CD1 8 (Mac-1) expression did not change with either dialyzer type. However, monocyt (p = 0.046) and granulocyte (p = 0.018) CD11b/CD18 ex pression in the post HD period was significantly lower using the vitamin E coated membrane compared with the contro cellulose membrane. Our findings suggest a significant de crease in activation and migration of monocytes and granu locytes when using a vitamin E coated cellulose membrane.

Effect of recombinant human erythropoietin on adrenergic activity in normotensive hemodialysis patients.

Ten normotensive hemodialysis patients with severe anemia participated in the study. Human recombinant erythropoietin (rHuEpo) was administered i.v. 3 times a week in doses of 50 U/kg of body weight. During 12 weeks of observation, the mean hematocrit value increased from 19%, before start of therapy, to 32%. Simultaneous monitoring of serum plasma noradrenaline (NA) concentration showed an elevation from 202 to 281 pg/ml. An increase of NA concentration after a cold pressure stimulating test (CP) was not statistically significant after as compared to before treatment, but became statistically significant after 12 weeks of rHuEpo therapy (281 pg/ml before to 441 pg/ml after CP test, p < 0.01). The mean arterial blood pressure increased from 92 - 109 mmHg after 12 weeks of rHuEpo therapy (p < 0.001). We have demonstrated significantly increased NA blood concentrations after 12 weeks of rHuEPO therapy in normotensive patients, which correlated with increased MAP. This may suggest that the observed increase of noradrenaline concentration as a vasoactive substance after the CP test may contribute to hypertension during rHuEPO therapy.

Effect of ultrafiltration on peripheral urea sequestration in haemodialysis patients.

BACKGROUND: Ultrafiltration (UF) is assumed to enhance urea removal during haemodialysis (HD) because of convective transport and because of contraction of urea distribution volume. However, UF-induced blood volume reduction has been hypothesized to enhance peripheral urea sequestration and post-dialysis urea rebound (PDUR), possibly reducing HD effectiveness. The effect of UF on PDUR was investigated in this study. METHODS: Nine HD patients were studied on two subsequent treatment days. The first HD was performed with UF (UF-rate=0.78+/-0.27 l/h), and the second treatment without UF. Serial measurements of serum water urea nitrogen concentration, arterial blood pressures (BP), and relative blood volume changes (BV%) were obtained over the duration of HD. RESULTS: BP and BV% decreased with UF (BP(sys)= -9%, BP(dia)=-8%, BP(mean)=-9%, BV%=-15%) but increased or remained unchanged without UF (BP(sys)= 9%, BP(dia)=12%, BP(mean)=11%, BV%=1%). PDUR was 28.6+/-9.6% without UF, and increased in every single patient with UF (40.7+/-13.2%, P<0.01). Modelled perfusion of the peripheral low-flow compartment decreased from 1.45+/-0.54 l/min without UF to 0.91+/-42 l/min with UF (P<0.05), thereby explaining an enhanced two-compartment effect and increasing PDUR. CONCLUSION: The significant increase in the two-compartment effect of urea kinetics observed in current HD accompanied by UF can be explained by compensatory, intradialytic blood flow redistribution induced by blood volume reduction. Because of the link between UF and blood flow, limited solute clearance treatment modes that optimize fluid removal such as variable UF will also have favourable effects on delivered dose of dialysis.

[Effect of vitamin E-modified membrane on expression of coreceptors CD4, CD8 on lymphocytes in chronic hemodialysis patients]. / Wplyw celulozowej blony dializacyjnej pokrytej witamina E na ekspresje koreceptorów CD4, CD8 na limfocytach u pacjentów z przewlekla niewydolnoscia nerek leczonych hemodializami.

Chronic renal failure induces a clinical state of cellular and humoral immunodeficiency that also depends on the time duration of blood contact with the wide spectrum of dialysis membranes use during long-term hemodialysis treatments. In end stage renal failure (ESRD) patients it is possible to induct state of chronic inflammation mostly caused by leukocytes and complement activation. It is postulated that the vitamin E-coated dialysis membrane minimalizes unbiocompatible reactions that generate smaller amounts of reactive oxygen species (ROS). The purpose of this study was to analyze the effect of classical and vitamin E coated cellulose membranes on the expression of CD 4 and CD 8 adhesion molecules on lymphocytes during HD in 10 patients using flow cytometric analysis. The study protocol included the measurement of molecules expression using cellulose membrane (Clirans RS15, TERUMO Corp., Japan), and the same membrane coated by vitamin E (Excebrane, Clirans E15, TERUMO Corp., Japan) during 20 dialysis sessions with each kind of membrane. During dialysis with classical cellulose membrane, significant decrease of lymphocyte serum level and increase of lymphocyte CD4 expression was observed. During the session with vitamin E coated membranes we did not observe any significant changes in serum CD4, CD8, CD4+8+ lymphocyte level, and also lymphocyte CD4, and CD8 expression on lymphocytes. Our findings suggest the potential role of vitamin E-coated cellulose membrane to minimalize negative reaction of the T lymphocyte subpopulation in ESRD patients treated on long-term dialysis.

[Selected aspects of rehabilitation programs for hemodialyzed patients in the United States ]. / Wybrane aspekty programów rehabilitacji w Stanach Zjednoczonych u pacjentów hemodializowanych.

The purpose of the paper was to evaluate some aspects of U.S. rehabilitation programs, and medical health systems legislatives initiatives in the patients with end-stage renal diseases treated with hemodialysis. We signalized potential problems, and complications of rehabilitation in such group of patients. The potential improvement in quality of life after intradialysis, and interdialysis rehabilitation was discussed.

Relative underestimation of fluid removal during hemodialysis hypotension measured by whole body bioimpedance.

Whole body bioimpedance is considered helpful in monitoring the removal of excess body water by ultrafiltration in hemodialysis patients. In this study, the cumulative, estimated decrease in extracellular volume (V(est)) modeled from whole body bioimpedance data was compared with measured volume (Vmeas) removed by ultrafiltration (UFR = 1.01 +/- 0.31 L/hr) in 12 patients during 36 high efficiency hemodialysis treatments. In the mean, estimated (V(est) = 3.0 +/- 1.4 L) and measured volumes (Vmeas = 3.4 +/- 1.1 L) correlated linearly: V(est) = 1.05 x Vmeas - 0.60, r2 = 0.68. Patients developed hypotension in half the treatments. Except for a larger decrease in systolic blood pressures in hypotensive (34 +/- 24 mmHg) vs. stable (14 +/- 15 mmHg) treatments, patient and treatment characteristics were not different between groups. However, at the end of hemodialysis, the difference V(est) - Vmeas was -0.8 +/- 0.9 L in hypotensive, and only 0.1 +/- 0.4 L in stable patients (p < 0.05). The difference between V(est) and Vmeas can be explained by a predominant removal of excess body water from central body compartments such as the trunk and the central blood volume during hypotension. These compartments are not adequately measured by whole body bioimpedance techniques. However, this information could be helpful in identifying patients with delayed peripheral fluid removal that may occur when either target weight is too low or UFR rates are too high.