Effect of Membrane Composition on Cytokine Production and Clinical Symptoms During Hemodialysis: A Crossover Study

Figures & data

Table 1. Dialyzer properties

Dialyzer membrane	Polysulfone	Cuprophan
Type	Synthetic	Cellulosic
Brand	Fresenius F6	Teremo C121
Surface area	1.2 m^2	1.2 m^2
Mass transfer coefficient (KoA)	670	645
Ultrafiltration coefficient (Kuf) mL/mmHg/h	5.5	6.1
Blood volume (mL)	83	88
Sterilization	ETO	ETO
Clearance at QB = 200 mL/mt
Urea	183	179
Creatinine	162	154
Phosphorus	130	126
B12	56	61

Table 2. IL-β and TNFα levels during hemodialysis (pg/mL)

Parameter	CU IL-1β	PS IL-1β	P value	CU TNFα	PS TNFα	P value
0 min	16.640 ± 2.215	21.550 ± 3.720	0.265	42.800 ± 4.519	117.100 ± 53.788	0.184
15 min	45.635 ± 16.239	71.105 ± 21.706	0.350	191.350 ± 55.309	240.000 ± 62.889	0.565
240 min	64.890 ± 25.166	103.550 ± 30.737	0.337	354.950 ± 80.442	387.050 ± 78.094	0.776
Increase in 1st 15 min	28.995 ± 14.971	45.555 ± 20.254	0.420	148.550 ± 54.845	122.900 ± 68.021	0.771
P value	0.068	0.024		0.014	0.087
Increase in 240 min	40.250 ± 23.838	82.000 ± 29.452	0.379	312.150 ± 80.564	269.950 ± 81.526	0.715
P value	0.057	0.012		0.001	0.004

CU = cuprophan, PS = polysulfone.

Table 3. Frequency of clinical symptoms on the two membranes

	Symptom	CU		PS		P value
1	Nausea	74	(62%)	65	(54%)	0.239
2	Vomiting	51	(42%)	30	(25%)	0.004
3	Cramps	2	(1.6%)	2	(1.6%)	1.000
4	Chest pain	9	(7.5%)	1	(0.8%)	0.010
5	Back pain	15	(12%)	23	(19%)	0.157
6	Fever	46	(38%)	12	(10%)	<0.001
7	Chills	51	(42%)	30	(25%)	0.004
8	Itching	8	(6.6%)	3	(2.5%)	0.123
9	Restlessness	10	(8.3%)	15	(12.5%)	0.291
10	Breathlessness	13	(10.8%)	0	(0%)	<0.001
11	Post DF	8	(6.6%)	3	(2.5%)	0.123
12	Hypotension	7	(5.8%)	5	(4.1%)	0.554

CU = cuprophan, PS = polysulfone.

Table 4. Comparison of cytokine rise in symptomatic sessions with rise in asymptomatic sessions (pg/mL)

	Symptom	IL-1β ↑ symptom −	IL-1β ↑ symptom +	P Value	TNFα ↑ symptom −	TNFα ↑ symptom +	P value
1	Nausea	31.5 ± 69.7	44.8 ± 84.0	0.182	199 ± 275	147 ± 266	0.429
2	Vomiting	42.6 ± 82	32.5 ± 70.4	0.321	150 ± 284	107 ± 238	0.216
3	Cramps	33.6 ± 78.9	17.2 ± 39.4	0.343	136 ± 271	87 ± 181	0.627
4	Chest pain	40.2 ± 79.6	16.9 ± 40.2	0.116	137 ± 274	87 ± 136	0.302
5	Back pain	40.5 ± 77.8	32.6 ± 82.4	0.589	138 ± 284	123 ± 178	0.671
6	Fever	45.5 ± 84.1	19.4 ± 52.7	0.006	140 ± 277	122 ± 247	0.644
7	Chills	50.0 ± 85.6	18.2 ± 56.8	0.001	132 ± 280	143 ± 250	0.758
8	Itching	40.8 ± 79.9	7.3 ± 17.2	<0.001	136 ± 272	125 ± 240	0.888
9	Restlessness	37.4 ± 77.0	55.3 ± 89.6	0.345	128 ± 240	198 ± 456	0.454
10	Breathlessness	41.1 ± 79.8	7.0 ± 37.4	0.009	136 ± 274	116 ± 177	0.707
11	Post DF	40.9 ± 79.9	4.1 ± 9.4	<0.001	136 ± 271	142 ± 261	0.904
12	Hypotension	40.9 ± 80.0	6.7 ± 14.3	<0.001	137 ± 272	94 ± 238	0.556

Symptom + = where the symptom occurred, symptom − = where the symptom did not occur.

Post DF = post dialysis fatigue.

Figure 1. Comparison of IL-1β levels during hemodialysis on CU and PS.

Figure 2. Comparison of TNFα levels during dialysis on CU and PS.

Figure 3.