BIOCOMPATIBLE MEMBRANES IN ACUTE-RENAL-FAILURE - PROSPECTIVE CASE-CONTROLLED STUDY

The mortality of critically ill patients with acute renal failure has been halved through intervention by haemodialysis. However, several re ports suggest that the course df the disorder may be prolonged by this procedure. Our prospective randomised study was done to see whether t he generation of inflammatory mediators by bio-incompatible membranes has an adverse effect on the outcome of acute renal failure. 52 patien ts, similar in age, severity of acute renal failure, general disease s tatus (APACHE II),and management of acute renal failure or its related conditions, were divided into two groups. Haemodialysis was done with cuprophane or polyacrylonitrile membranes. Cuprophane membranes induc ed intense activation of the complement system (as judged by measureme nt of C3a) and lipooxygenase pathway (leukotriene 84) resulting in alt erations of neutrophil kinetics and function. The cuprophane group had a lower survival rate (38 vs 65%), a higher proportion of patients dy ing from sepsis (71 vs 40%), required more haemodialysis sessions (12 vs 9), and demonstrated delayed resolution and recovery from acute ren al failure than the polyacrylonitrile group. The difference in mortali ty regarding lethal sepsis as cause of death was statistically signifi cant. Our observations indicate that the outcome of critically ill pat ients with acute renal failure may be influenced by bio-incompatibilit y reactions to the dialysis membrane. These results have direct implic ations for such patients on haemodialysis.