Nitric oxide release in the peripheral blood during hemodialysis

Abstract

These studies evaluated the nitric oxide (NO) release in peripheral blood during a four-hour hemodialysis (HD) with single-used cuprophane (CU), polysulfone (PS) and polyacrylonitrile (PAN) membranes in 10 chronic uremic patients. Continuous monitoring of blood NO concentrations was performed with a sterile NO sensor probe inserted vertically into the arterial blood line between the arteriovenous fistula and dialyzer. In the initial period of HD two peaks of blood NO concentrations were observed: the first occurred at the very start of HD and lasted approximately one minute, and the second peaked to a lesser extent at 20 to 26 minutes after the initiation of HD. The extent of NO release was dependent on the type of dialysis membrane used. Areas under curves for blood NO concentrations (in μmol x min) were as follows: CU, 450.8 ± 163.3; PS, 247.3 ± 150.6*; PAN, 200.4 ± 91.0* (*P < 0.05 vs. CU). During the first hour of HD (N = 6) blood NO concentrations were significantly higher at the outlet of CU dialyzer than those found at the inlet. The areas under their curves (in μmol x min) were 169.1 ± 1.9 and 107.5 ± 1.6, respectively (P < 0.001). Areas under curves for blood NO concentrations measured for five minutes following a five-minute in vitro incubation of 5 ml heparinized uremic blood samples (N = 10) with dialysis membranes (50 cm2) were as follows (in nmol x min): CU, 2380 ± 289*; PS, 1293 ± 45*; PAN, 1117 ± 37*; control, 502 ± 56 (*P < 0.05 vs. control). The addition of sodium heparin to uremic blood platelet suspension induced an immediate rise in NO release in a dose-dependent manner, which proved to be a hyperbolic relationship. During HD with CU (N = 6), PS (N = 6) and PAN (N = 6) membranes blood plasma cGMP concentrations significantly increased, particularly at 20 and 60 minutes of the procedure. No significant differences in blood plasma cGMP levels were found between individual dialysis membranes, and no significant correlations were observed between blood plasma cGMP levels and blood NO concentrations. The results indicate that during HD NO is released in the peripheral blood due to blood-membrane and heparin-blood platelet interactions. The extent of intradialytic NO release is dependent on the type of dialysis membrane used (CU > PS ~ PAN).