INTERLEUKIN-1 AND INTERLEUKIN-1 RECEPTOR ANTAGONIST PRODUCTION DURINGHEMODIALYSIS - WHICH CYTOKINE IS A SURROGATE MARKER FOR DIALYSIS-RELATED COMPLICATIONS

Studies have shown differences between host defence dysfunctions in pa tients with end-stage renal disease (ESRD), patients treated with cont inuous ambulatory peritoneal dialysis (CAPD) and those undergoing chro nic haemodialysis. Immune dysfunction is well documented in haemodialy sis patients, particularly after a few years of dialysis treatment. Th e unresolved question is whether there is a surrogate marker(s) for di alysis-related changes which can be monitored easily and which prospec tively predicts deteriorating health, dialysis-related complications a nd/or mortality. The issue is one of finding a marker for host perturb ation solely related to haemodialysis. The criteria for such a marker( s) worthy of being investigated are: (1) does it change with alteratio ns made to the membrane or the quality of the dialysate; (2) is the ma rker independent of the patient's intrinsic renal disease; (3) does th e marker reflect the pathophysiology of 'bioincompatibility'? In this overview, the effects of chronic haemodialysis on interleukin-l (IL-1) and IL-1 receptor antagonist (IL-1Ra) production by peripheral blood mononuclear cells will be discussed. Recent data suggest that IL-1Ra r ather than IL-1 itself is a marker for chronic monocyte activation and bioincompatibility.