Effect of Dialyzer Membrane on TNF-alpha and Blood Coagulation System

Han, Kum Hyun; Lee, Ji Eun; Seo, Ji A; Sung, Su Ah; Lee, So Young; Jo, Sang Kyung; Cho, Won Yong; Kim, Hyung Kyu

Abstract

BACKGROUND: Blood-dialyzer membrane interaction in hemodialysis has the potential to activate blood coagulation and fibrinolysis, and it might elicit production of inflammatory cytokine such as TNF-alpha by monocytes activation. The aim of the present study was to; i) assess changes in coagulation status, fibrinolytic activity and plasma level of TNF-alpha during hemodialysis; ii) determine whether the extent of activation is dependent on the dialyzer material used.
METHODS
Twenty-five end-stage renal failure patients who had undergone maintenance hemodialysis were included in the study. Patients were randomly divided into two groups; one using hemophan dialyzer membrane (n=13) and the other using polysulfone dialyzer membrane (n=12). On sixth dialysis session, blood samples were obtained before and at the end of hemodialysis. Thrombin-antithrombin complex (TAT) and D-dimer, each reflecting in vivo thrombin generation and fibrin degradation product respectively, were measured for coagulatory and fibrinolytic activity. Tissue plasminogen activator (tPA), plasminogen activator inhibitor-1(PAI-1), and fibrinogen were measured. Activated partial thromboplastin time (aPTT) was measured for efficancy of anticoagulant. Plasma level of TNF-alpha was also measured.
RESULTS
During hemodialysis, plasma level of TNF-alpha did not change. Between hemophan dialysis and polysulfone dialysis group, the change in plasma level of TNF-alpha (delta TNF-alpha ) was not different. Significant changes were observed in aPTT, fibrinogen, TAT, D-dimer, tPA during hemodialysis (p<0.05) except in PAI-1 (p=0.71). Between two groups, changes in aPTT, fibrinogen, D-dimer, PAI-1 and tPA (delta aPTT, delta fibrinogen, delta D-dimer, delta PAI-1, delta tPA) were not different (p>0.05). However, the change in TAT (delta TAT) was significantly lower in polysulfone dialysis group (p=0.049).
CONCLUSION
Hemodialysis enhances coagulatory activity despite the use of anticoagulant and also enhances fibrinolytic activity, which is likely the result of tPA release. In activation of coagulatory system, biocompatibility of polysulfone membrane is superior to that of hemophan membrane. Plasma level of TNF-alpha did not change during hemodialysis, further study should be considered.