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Marants R, Qirjazi E, Lai KB, Szeto CC, Li PKT, Li F, Lee TY, McIntyre CW. Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis. Kidney Int Rep 2021; 6:1336-1345. [PMID: 34013112 PMCID: PMC8116762 DOI: 10.1016/j.ekir.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction The liver receives gut-derived endotoxin via the portal vein, clearing it before it enters systemic circulation. Hemodialysis negatively impacts the perfusion and function of multiple organs systems. Dialysate cooling reduces hemodialysis-induced circulatory stress and protects organs from ischemic injury. This study examined how hemodialysis disrupts liver hemodynamics and function, its effect on endotoxemia, and the potential protective effect of dialysate cooling. Methods Fifteen patients were randomized to receive either standard (36.5°C dialysate temperature) or cooled (35.0°C) hemodialysis first in a two-visit crossover trial. We applied computed tomography (CT) liver perfusion imaging to patients before, 3 hours into and after each hemodialysis session. We measured hepatic perfusion and perfusion heterogeneity. Hepatic function was measured by indocyanine green (ICG) clearance. Endotoxin levels in blood throughout dialysis were also measured. Results During hemodialysis, overall liver perfusion did not significantly change, but portal vein perfusion trended towards increasing (P = 0.14) and perfusion heterogeneity significantly increased (P = 0.038). In addition, ICG clearance decreased significantly during hemodialysis (P = 0.016), and endotoxin levels trended towards increasing during hemodialysis (P = 0.15) and increased significantly after hemodialysis (P = 0.037). Applying dialysate cooling trended towards abrogating these changes but did not reach statistical significance compared to standard hemodialysis. Conclusion Hemodialysis redistributes liver perfusion, attenuates hepatic function, and results in endotoxemia. Higher endotoxin levels in end-stage renal disease (ESRD) patients may result from the combination of decreased hepatic clearance function and increasing fraction of liver perfusion coming from toxin-laden portal vein during hemodialysis. The protective potential of dialysate cooling should be explored further in future research studies.
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Affiliation(s)
- Raanan Marants
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Elena Qirjazi
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.,Division of Nephrology, Alberta Health Sciences, Calgary, Alberta, Canada
| | - Ka-Bik Lai
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip K T Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Fiona Li
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Christopher W McIntyre
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
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Menegatti E, Roccatello D, Rossi D, Formica M, Piccoli G, Sena LM. 5-Lipoxygenase gene expression in hemodialysis. Artif Organs 1998; 22:140-2. [PMID: 9491904 DOI: 10.1046/j.1525-1594.1998.06047.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Leukotrienes (LTs), the end products of the eicosanoid pathway released during inflammation, are markers of polymorphonuclear cell and monocyte activation. The present study focused on the possibility that 5-lipoxygenase (5-LO), the key enzyme for LT synthesis, was involved in the interaction between blood and the hemodialysis (HD) membrane. 5-LO gene expression was examined by reverse transcriptase polymerase chain reaction (RT-PCR) in samples of mononuclear cells isolated from peripheral blood withdrawn at the start and at 15 min of HD from 10 chronic HD patients, 5 treated with Cuprophan and 5 with polymethylmethacrylate (PMMA) membrane. An increased 5-LO gene expression was detected at 15 min in 4 of 5 patients using the Cuprophan membrane but in none of the 5 PMMA treated patients. Our results showed for the first time that the interaction between blood and the HD membrane upregulates 5-LO messenger ribonucleic acid (mRNA).
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Affiliation(s)
- E Menegatti
- Dipartimento di Medicina e Oncologia Sperimentale, Sezione di Patologia Generale, Università di Torino, Italy
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Kanai H, Nagashima A, Hirakata E, Hirakata H, Okuda S, Fujimi S, Fujishima M. The effect of azelastin hydrochloride on pruritus and leukotriene B4 in hemodialysis patients. Life Sci 1995; 57:207-13. [PMID: 7596227 DOI: 10.1016/0024-3205(95)00264-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pruritus is a very common complication in chronic hemodialysis (HD) patients, however the exact mechanism for this affliction is still not known. Anti-histaminics usually failed to alleviate uremic pruritus. In others, an anti-allergic drug, which inhibits the release of chemical mediators, such as leukotrienes or histamine from mast cells, was reported to be effective. We evaluated the values of leukotriene B4 and interleukin 6 in HD patients with pruritus and the effect of an anti-allergic drug on these factors. Leukotriene B4, interleukin-6, C3a, C5a, the number of eosinophil and IgE at 0, 15 and 180 minutes after the start of regular HD in 11 HD patients suffering from pruritus and as well as in 11 HD patients without pruritus were examined. These HD patients in both groups showed significantly higher (p < 0.001) values of leukotriene B4 and C3a compared to healthy non-HD subjects. There was no difference in the leukotriene B4, interleukin-6, IgE, C3a and C5a levels between the patients with and without pruritus. Two mg/day of azelastin hydrochloride, an anti-allergic drug was orally given to the pruritus group for 3 weeks. In 5 of 11 patients, the pruritus symptoms disappeared, while in 4 of 11 they improved. Independent of the effect of the drug on pruritus, leukotriene B4 levels significantly decreased compared with those before the administration of this drug in the pruritus group (p < 0.01). Interleukin 6, C3a, C5a and the number of eosinophils demonstrated no significant change. In conclusion, although azelastin hydrochloride was effective in treating pruritus and also suppressed leukotriene B4 levels in hemodialysis patients, the high leukotriene B4 activity itself did not seem to be related to the development of pruritus in these patients.
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Affiliation(s)
- H Kanai
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka City, Japan
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Abstract
This review examines the mechanisms by which bioincompatibility in dialysis systems may have an effect on morbidity and mortality in the dialysis population. Direct toxic effects of membrane materials and various chemical substances have been well demonstrated in the chronic dialysis population. Activation of the complement cascade and stimulation of cytokine production may have autocrine effects on leukocyte function with sequelae such as enhanced rates of infection and the development of B2-microglobulin amyloidosis. The variable effect of different membrane materials on each of these effector systems is examined. Bioincompatibility may effect the incidence of infection, malignancy, cardiopulmonary disease, and malnutrition as well as induce novel disease processes. All these confounding variables must be considered when evaluating the effect of dialysis on mortality and morbidity.
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Affiliation(s)
- J M Lazarus
- Department of Medicine, Harvard Medical School, Boston, MA
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Tridon A, Palcoux JB, Jouanel P, Bezou MJ, Coulet M, Betail G. Complement activation during low-density lipoprotein apheresis. Artif Organs 1992; 16:577-85. [PMID: 1482327 DOI: 10.1111/j.1525-1594.1992.tb00555.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Complement system activation was investigated in two girls with familial homozygous hypercholesterolemia undergoing two monthly sessions on LA15 or LA40 (Kaneka liposorber). We determined blood levels of C3c and C3a, leukocyte counts, and plasma levels of C3c and C3a in the extracorporeal circulation device at the start of the sessions and 15 and either 60 or 120 min into them. Sequential eluates were collected from LA40 at the end of the sessions (0.5M NaCl, 1M hydroxylamine). Anaphylatoxin C3a increased throughout, especially with LA40. As previously reported, C3a was trapped in the dextran column but was noticeably present in efferent plasma. Besides many proteins, nonnative complement fragments bearing C3a and C3d antigens were detected in almost all the eluates, suggesting possible in situ complement activation. Practically, complement activation induced by the first filter is a risk; long-term side effects may arise from this extracorporeal circulation device.
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Affiliation(s)
- A Tridon
- Laboratoire d'Immunologie, CHRU Clermont-Ferrand, France
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