It is well known that chronic renal patients undergoing hemodialysis have several
indices of immune deficlency. It is suggested that immune deficiency, especially defects in cell mediated immunity is caused by uremia itself, and somewhat related with dialysis.
And the effect of hemodialysis on immune status of the patients may be associated with the biocompatibility of the dialysis membrane. The magnitude of the changes in a blood
constituents on exposure to the dialysis membrane has been used as an index of biocompatibility.
To evaluate the influence of different dialysis membrane, cuprophane membrane and
polymethyl methacrylate(PMMA) membrane, on the immune status of chronic renal failure patients on hemodialysis, prospective crossover design study was performed on 15 patients receiving chronic hemodialysis with PMMA membrane for 17
months.
All
the parient included in the study were chronic renal failure patient and had no systemic disease affecting immune status of the patients. Study was performed in 3 phase. In phase I patients were dialysed with cuprophan membrane for 5
weeks,
in
phase II the patients were switched to 5 weeks of PMMA membrane dialysis and then they were returued to 5 weeks of cuprophane membrane dialysis in phase III. Blood samples for various indices of immune status of the patients were
obtained at
the beginning at the and end of each phase. Control blood samples were obtained from 10 healthy adults. The results are as follows.
1. Serume 2 microglobulin in patient group were significantly elevated than in the normal control group(28.32±11.8 vs 1.171±0.18 g/dl, p<0.05). In phase I and phase III, there are significant(p<0.05) elevation of serum 2
microglobulin,
namely from 28.32±11.28 to 31.89±8.38 and from 35.00±11.29 to 38.27±12.42 g/ml, respectively. But in phase II, dialysis with PMMA membrane, there was no significant change in serum 2 microglobulin level.
2. Serum soluble interleukin 2 receptor(sIL-2R) levels were markedly evevated in patient group I (1564±712 vs 495±105 /ml, p<0.05). There were significant elevation of sIL-2R level in phase I and phase III, from 1564±713 to 1928±542 in
phase
I and from 1744±508 to 1958±634 u/ml in phase III. but in phase II, serum sIL-2R level did not change significantly.
3. There were no significant difference of interleukin 2 receptor(IL-2R) expression in peripheral lymphocyte between patient group and normal control. Also there are no significant
changes of IL-2R expression according to dialysis membrane.
4. Other immumologic parameters, serum C3 level, T4/T8 cell ratio and NK/T cell ratio are decreased significantly in patient group. but there are no significant changes in serum level according to each phase.
Above results suggest that chronic dialysis with either PMMA membrance or cuprophane membrane may result to be a factor in the immune deficiency status in chronic renal faiure. Because PMMA membrane results in less elevation in 2
microglobulin and sIL-2R, it may be suggested that cuprophan membrane may be more bioimcompatible than PMMA membrane.
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