Effects of acetate dialysate on transforming growth factor β₁, interleukin, and β₂-microglobulin plasma levels

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.