Divisione di Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Università Cattolica del Sacro Cuore, Rome, Italy; UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Cytokine. 2020 Nov;135:155223. doi: 10.1016/j.cyto.2020.155223. Epub 2020 Aug 13.
The aetiology of postdialysis fatigue (PDF), an intermittent but debilitating fatigue occurring after haemodialysis (HD) treatment, is still unclear. In other inflammatory diseases, increasing evidence points toward the involvement of the immune system in the onset of fatigue symptoms. Altered serum levels of inflammatory cytokines have also been shown in HD patients. Therefore, we investigated whether pre- and postdialysis serum levels of pro- and anti-inflammatory cytokines (i.e. IL-1β, IL-6, TNF-α and IL-10) or their intradialytic changes (if any) were related to PDF or the time HD patients reported needing to recover from HD treatment (TIRD).
Serum levels of IL-1β, IL-6, TNF-α and IL-10 were measured immediately before and after HD in 45 patients using commercially available kits on an ELLA™ automated immunoassay system. The presence and severity of PDF as well as TIRD duration were assessed by self-report measures.
Seventy-four percent of patients reported PDF, with a median PDF severity index of 3.30 [IQR: 3.00-4.30] on a scale from 1 to 5. Median TIRD was 120 min [IQR: 60-480]. PDF severity correlated strongly with TIRD, r = 0.85, p < 0.001. Only predialysis levels of IL-10 significantly and positively correlated with PDF severity (r = 0.43, p = 0.003).
Findings of the present study do not support the involvement of the immune system in the onset of PDF or the time patients needed to recover from HD treatment. A positive, but counterintuitive relationship was found between predialysis levels of anti-inflammatory IL-10 and PDF severity, which warrants further research.
透析后疲劳（PDF）是一种发生在血液透析（HD）治疗后的间歇性但使人虚弱的疲劳，其病因仍不清楚。在其他炎症性疾病中，越来越多的证据表明免疫系统参与了疲劳症状的发生。HD 患者的血清炎症细胞因子水平也发生了改变。因此，我们研究了促炎和抗炎细胞因子（即 IL-1β、IL-6、TNF-α 和 IL-10）的透析前和透析后血清水平，或其（如果有的话）透析内变化是否与 PDF 或 HD 患者报告需要从 HD 治疗中恢复的时间（TIRD）有关。
使用 ELLA™ 自动免疫分析系统上的商业试剂盒，在 45 例患者中，在 HD 前后立即测量 IL-1β、IL-6、TNF-α 和 IL-10 的血清水平。通过自我报告措施评估 PDF 的存在和严重程度以及 TIRD 持续时间。
74%的患者报告存在 PDF，其 PDF 严重程度指数中位数为 3.30 [IQR：3.00-4.30]，分值范围为 1 至 5。TIRD 的中位数为 120 分钟 [IQR：60-480]。PDF 严重程度与 TIRD 高度相关，r=0.85，p<0.001。只有透析前的 IL-10 水平与 PDF 严重程度呈显著正相关（r=0.43，p=0.003）。
本研究结果不支持免疫系统参与 PDF 的发生或患者从 HD 治疗中恢复所需的时间。我们发现了一种相反的、正向的关系，即透析前抗炎性 IL-10 水平与 PDF 严重程度之间存在正相关，这值得进一步研究。
