ELEVATED LEVELS OF TUMOR-NECROSIS-FACTOR-ALPHA IN POSTDIALYSIS FATIGUE

Postdialysis fatigue (PDF) has been ascribed to excessive ultrafiltrat ion and decline in osmolality during hemodialysis. We evaluated the po tential role for the sommogenic cytokines, interleukin-1 beta (IL-IR) and tumor necrosis factor alpha (TNF alpha), in the genesis of PDF: Pa tients dialyzing with cuprophane membrane were assigned to PDF (N=25) and non-PDF (N=25) groups based on a fatigue index questionnaire. Pre- and postdialysis samples were obtained from 3 consecutive treatments a nd later assayed for serum levels of IL-1 beta and TNF alpha by ELISA. Our results show significant intradialytic elevation of TNF alpha in both non-PDF groups (non-PDF: pre -3.36+/-0.80 pg/ml to post 3.75+/-0. 88 pg/ml, p<0.04; PDF: pre-5.95+/-0.80 pg/ml to post- 8.66+/-1.35 pg/m l, p<0.02). The degree of intradialytic augmentation was significantly greater for TNF alpha in the PDF group (46 +/- 18% vs 11 +/- 5%; p<0. 03). There were no significant intradialytic changes in serum levels o f IL-IR in either the PDF or non-PDF groups. There also were no signif icant differences in dialysis-related body weights, systolic blood pre ssures, or osmolalities. These findings suggest that TNF alpha may be involved in the pathogenesis of PDF.