Effects of Different Levels of Endotoxin Contamination on Inflammatory Cytokine Production by Peripheral Blood Mononuclear Cells after High-Flux Hemodialysis

Article contributed by Mr CS Choong  

Kearkiat Praditpornsilpa^a, Khajohn Tiranathanagul^a, Paweena Susantitaphong^a, Pisut Katavetin^a, Thananda Trakarnvanich^b, Natavudh Townamchai^a, Talerngsak Kanjanabuch^a, Yingyos Avihingsanon^a, Kriang Tungsanga^a, Somchai Eiam-Ong<sup>a

a</sup>Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and
^bRenal Unit, Department of Medicine, Bangkok Metropolitan Administration Medical College, Bangkok, Thailand

Blood Purif 2011;32:112-116 (DOI: 10.1159/000324394)


Abstract    

                                                                                             

Background: 
In Thailand, dialysate endotoxin contamination levels vary from less than 0.001 to 2.0 EU/ml. This difference has prompted an investigation on the production of proinflammatory cytokines and counter inflammatory mediators of peripheral blood mononuclear cells (PBMCs) after high-flux dialysis.                                                                                
                                                                                                   
Methods: 
Patients from four hemodialysis (HD) centers who met the inclusion/exclusion criteria were enrolled into the study. PBMCs were isolated by Ficoll density gradient centrifugation and cultured. Supernatants were tested for interleukin 6 (IL-6), IL-1β and IL-1 receptor antagonist (IL-1Ra) concentration by ELISA.                                                                   
                                                                                                   
Results: 
HD centers 1, 2, 3 and 4 had mean dialysate endotoxin contamination levels of 0.001, 0.026, 0.558 and 1.960 EU/ml, respectively. HD center 4 had the highest levels of IL-6 (1,052.3 ± 240.7 pg/106 PBMCs), IL-1β (1,297.1 ± 334.6 pg/106 PBMCs) and IL-1Ra (2,713.4 ± 1,255.3 pg/106 PBMCs). There were no significant differences in cytokine production between HD centers 1 and 2.                                                                       
                                                                                                   
Conclusion:  
Our study showed that ultrapure dialysate can minimize the risk of stimulating inflammatory cells. Ultrapure dialysate may prevent or delay endotoxin exposure-related complications.