CHRONIC AND INTRADIALYTIC EFFECTS OF HIGH-FLUX HEMODIALYSIS ON TUMOR-NECROSIS-FACTOR-ALPHA PRODUCTION - RELATIONSHIP TO ENDOTOXINS

Tumor necrosis factor-α (TNFα) likely plays a role in hemodialysis-associated complications. As TNFα is mainly produced by monocytes in response to endotoxins, we studied its production and the presence of circulating endotoxins in patients dialyzed on polyacrylonitrile (PAN) membrane. Spontaneous production of TNFα was observed in patients before the dialysis session and increased during the session. Endotoxins were present in serum from patients chronically dialyzed with PAN and increased during hemodialysis session. In addition, intradialytic decrease in CD14 antigen expression on circulating monocytes, which could be caused by endotoxins, was found. The continuous presence of low amounts of circulating endotoxins between sessions may explain the chronic increase in TNFα secretion, while high amounts of circulating endotoxins may account for intradialytic oversecretion of TNFα and downmodulation of CD14. We suggest that endotoxin-free dialysates should be a prerequisite for the use of high-flux membranes. © 1992, National Kidney Foundation. All rights reserved. All rights reserved.