EFFECT OF HEMODIALYSIS ON LEUKOCYTE ADHESION RECEPTOR EXPRESSION

Hemodialysis with complement-activating membranes such as cuprophane i s known to transiently activate leukocytes, leading to increased cellu lar adhesiveness, pulmonary leukostasis, and reduced functional capaci ty of monocytes and neutrophils, Clinically, this repetitive cell acti vation may contribute to the increased morbidity and mortality associa ted with chronic hemodialysis. To examine the effect of cuprophane hem odialysis on expression of cell-surface proteins involved in leukocyte adhesiveness, we monitored CD11b, CD18, CD14, CD54, and plasma-solubl e CD54 in 10 patients during hemodialysis with cuprophan dialyzers. To test the effect of local blood recirculation, in two patients, arteri al supply to the dialyzer was accessed from the peripheral arterioveno us fistula and was returned via an indwelling central venous catheter. In an attempt to examine the possible role of membrane-induced comple ment activation, the results were compared with those seen after incub ation with C5a in vitro, Finally, the leukocyte responses to C5a and l ipopolysaccharide were measured before and after hemodialysis, Leukocy te expression of CD11b and CD18 increased and CD14 decreased with hemo dialysis, while CD54 remained unaltered. Plasma CD54 was markedly elev ated before and remained unchanged during hemodialysis, Data obtained with C5a activation in vitro revealed identical changes in CD11b expre ssion as that seen with hemodialysis, suggesting the role of membrane- induced complement activation, Preliminary data obtained using remote arterial and venous access sites showed only a slight increase in CD11 b expression in the arterial blood, suggesting that the apparent syste mic activation seen with arteriovenous access may be due to recirculat ion and local activation within the blood access. Finally, dialysis pr ocedure did not impair lipopolysaccharide- or C5a-mediated upregulatio n of CD11b expression. (C) 1996 by the National Kidney Foundation, Inc .