HDCN Article Review/Hyperlink

Kranzlin B, Gretz N, Kirschfink M, Mujais SK

Dialysis in rats with acute renal failure: evaluation of three different dialyzer membranes

Artif Organs (Nov) 20:1162-1168 1996

Whether cuprophan dialysis membranes increase morbidity/mortality in the treatment of ARF is a topic of current debate. There are presently two positive and one negative clinical paper in this area. One of the theoretical underpinnings of this hypothesis was a study by Schulman and Hakim (Kidney Int 40:1069-1074, 1991) where rats with ischemic ARF injected with complement activated blood had neutrophil infiltration of glomeruli and delayed recovery of function.

In this paper, which was presented at ASN in 1994, Kranzlin et al. apparently tried and failed to replicate the results of Schulman et al. In 48 rats, crossclamping of both renal arteries for 45 or 60 min was used as the ischemic insult. Rats were then randomized to receive either no dialysis, or dialysis with cuprophan, AN69, or hemophan mini-dialyzers. Dialysis was performed only twice, for 60 min each time on days 4 and 8 after renal crossclamping. GFR was measured on days 5 and 9 by inulin clearance. To make a long story short, these investigators found no difference in the rate of renal recovery in the dialyzed rats, and the membrane used made no difference.

Comment: The difference between this and the Schulman study was, that in the latter, complement-activated plasma was injected during the induction phase of renal injury. Kranzlin et al argue that this does not correspond to the clinical situation. On the other hand, the total exposure to dialysis membranes in the present study was short (two 1-hour sessions 4 days apart). It would have been nice if the authors had replicated exactly Schulman's design, and used this as a "positive control", and then used graded amounts of exposure to complement activation to determine if a critical amount and time course could be demonstrated. (John T. Daugirdas, M.D., University of Illinois at Chicago)