Systemic Levels of Tumor Necrosis Factor Alpha During Hemodialysis with Cellulosic Membranes: No Effect of the Sterilization Procedure

摘要

Abstract:Extractable constituents of dialyzer membranes (e.g., monomers and †‐glucans) may induce the production of cytokines in vitro. We therefore studied circulating tumor necrosis factor alpha (TNFα) levels in 23 stable hemodialysis patients during treatment with dry Cuprophan membranes (ETO‐sterilized n = 10, steam‐sterilized n = 13) longitudinally over a period of 4 weeks. After 4 weeks, those 5 patients of each group showing the highest TNFα levels were switched to steam‐sterilized, wet Cuprophan membranes. No significant increase in plasma TNFα was observed during hemodialysis with either ETO‐ or steam‐sterilized dry Cuprophan membranes. A substantial TNFα increase (≥ 100 compared to pre‐HD values), however, was observed during 14 of 84 treatment sessions. In 5 selected patients with ETO‐sterilized, dry Cuprophan dialyzers, TNFα rose from (mean ± SEM) 17.2 ± 3.0 (pre‐HD) to 20.9 ± 6.2 (120 min) and 21.9 ± 4.5 pg/ml (240 min). Corresponding levels in patients with steam‐sterilized, dry Cuprophan were 16.2 ± 5.4 (pre‐HD), 21.9 ± 6.8 (120 min), and 16.0 ± 3.7 pg/ml (240 min), respectively. There was no difference between ETO‐ and steam‐sterilized dialyzers. No significant reduction in mean TNFα plasma levels or in frequency of elevated peak levels was achieved when these patients were switched to wet Cuprophan dialyzers for another 4 weeks. It is suggested that an induction of elevated TNFα levels during hemodialysis is possible but is not observed regularly during treatment with Cuprophan membranes. Moreover, wet storage of dialyzers (allowing for better extraction of cytokine‐inducing material) did not prove to be superior to conventiona