Interleukin-1 and interleukin-1 receptor antagonist production during haemodialysis: which cytokine is a surrogate marker for dialysis-related complications?

Studies have shown differences between host defence dysfunctions in patients with end-stage renal disease (ESRD), patients treated with continuous ambulatory peritoneal dialysis (CAPD) and those undergoing chronic haemodialysis. Immune dysfunction is well documented in haemodialysis patients, particularly after a few years of dialysis treatment. The unresolved question is whether there is a surrogate marker(s) for dialysis-related changes which can be monitored easily and which prospectively predicts deteriorating health, dialysis-related complications and/or mortality. The issue is one of finding a marker for host perturbation solely related to haemodialysis. The criteria for such a marker(s) worthy of being investigated are: (1) does it change with alterations made to the membrane or the quality of the dialysate; (2) is the marker independent of the patient's intrinsic renal disease; (3) does the marker reflect the pathophysiology of 'bioincompatibility'? In this overview, the effects of chronic haemodialysis on interleukin-1 (IL-1) and IL-1 receptor antagonist (IL-1Ra) production by peripheral blood mononuclear cells will be discussed. Recent data suggest the IL-1Ra rather than IL-1 itself is a marker for chronic monocyte activation and bioincompatibility.