Effects of Acetate Dialysate on TGFβ-1, Interleukin, and β2-microglobulin Plasma Levels

Abstract

To evaluate potential adverse effects of acetate use in hemodialysis (HD), we measured plasma interleukin (IL-1α, IL-1β, IL-6). TNFα, TGFβ1, and β2-microglobulin levels with ELISA assays in normal (N = 9), CRF (N = 6), CAPD (N = 7) and HD (N = 8) subjects and compared the effects of acetate (Ac) and acetate-free (Ac-free) dialysate. TGFβ1, was the only cytokine consistently detected. Compared to normals (median 57, range 53 to 68 pg/ml, one undetected; N = 8). TGFβ1, was higher in the CRF (75, 70 to 97 pg/ml, one undetected) and CAPD (75.5, 66 to 116 pg/ml. N = 6) groups (P < 0.05), and was somewhat higher in the HD (68, 52 to 88 pg/ml) group (P < 0.10). Acutely, TGFβ1, pre-HD (70, 63 to 88 pg/ml) increased above normals post AcHD [79.5. 65 to 140 pg/ml uncorrected for Ultrafiltration (UF)] and was higher after AcHD versus Ac-free HD both uncorrected (79.5. 65 to 140 pg/ml vs. 70, 52 to 86 pg/ml) and corrected for UF (68, 51 to 115 pg/ml vs. 57, 43 to 69 pg/ml; P < 0.05). β2-microglobulin was not different after AcHD (81.2 ± 8.0 mg/ml) versus Ac-free HD (72.5 ± 6.9 mg/ml). Signifcantly lower serum inorganic phosphorus was also found four hours post-AcHD compared to four hours post-Ac-free HD (0.87 mmol ± 0.10 SEM vs. 1.05 mmol ± 0.07 SEM; P < 0.05). Inflammatory cytokines may, therefore, not be detectable with standard ELISA assays even after HD. TGFβ1, which stimulates extracellular matrix and collagen synthesis and modulates other cytokines. could affect the progression of CRF and combined with acetate's possible effects on phosphate kinetics, could play a role in ectopic calcifications and renal bone disease. Finally, no effect of acetate on β2-microglobulin levels was found.