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Biocompatibility of dialysis membranes: Effects of chronic complement activation

1984; Elsevier BV; Volume: 26; Issue: 2 Linguagem: Francês

10.1038/ki.1984.155

1523-1755

Raymond M. Hakim, Douglas T. Fearon, J. Michael Lazarus, Cynthia S. Perzanowski,

Acute Kidney Injury Research

Blocompatibility of dialysis membranes: Effects of chronic complement activation.The ability of three dialysis membranes (cuprophane, cellulose acetate, and polymethylmethacrylate) to activate complement was studied prospectively in ten chronic dialysis patients using new and reused membranes.Patients were dialyzed for 1 month with each type of membrane.New cuprophane membranes caused the most intense activation, while polymethylmethacrylate (PMMA) surfaces caused the least degree of complement activation.Reuse decreases the capacity of the cuprophane membrane to activate complement but does not significantly alter the capacity of cellulose acetate membranes.The extent of complement activation paralleled the ability of these membranes to induce neutropenia.Recurrent dialysis with new cuprophane and cellulose acetate membranes leads to a decrease in pre-dialysis and rebound leukocytosis" neutrophil count, as well as a more intense activation of complement and an enhanced endogenous clearance of products of complement activation.The clinical sequelae of recurrent complement activation are discussed.Biocompatibilite des membranes de dialyse: effets de l'activité chronique du complement.La capacitC de trois membranes de dialyse (cuprophane, acetate de cellulose, et polymCthylmethacrylate) d'activer le complement a été étudiée prospectivement chez dix dialyses chroniques en employant des membranes neuves ou déjà utilisCes.Les malades ont été dialyses pendant I mois avec chaque type de membrane.Les membranes neuves en cuprophane entrainaient l'activation Ia plus intense, tandis que les surfaces en polymethylmethacrylate (PMMA) étaient responsables du moindre degre d'activation du complement.La rëutilisation diminue Ia capacité de Ia membrane de cuprophane a activer Ic complement mais ne modifie pas significativement celle des membranes en acetate de cellulose.L'importance de l'activation complementCmique était parallele a Ia capacité de ces membranes dinduire une neutropénie.Des dialyses repetees avec des membranes neuves de cuprophane ou d'acétate de cellulose conduisent a une baisse de Ia numeration des neutrophiles predialytique et a Ia "hyperleucocytose de rebound," a une activation plus intense du complement et a une stimulation de l'Climination endogCne des produits de l'activation du complement.Les conséquences cliniques d'une activation rCpCtee du complement sont discutées.Recent studies confirm that the complement system is activated during hemodialysis [1, 21.This activation is more intense with cuprophane membrane than cellulose acetate [3] or polyacrylonitrile (PAN) membranes [1] and for cuprophane, it