Induction of Tumor Necrosis Factor during Extracorporeal Blood Purification

To the Editor: Recent studies have shown that blood monocytes become activated during regular hemodialysis and produce interleukin-1.^{1 2 3} Monocyte products such as interleukin-1 are thought to contribute to both the short-term and long-term changes that are observed with hemodialysis and, to a lesser extent, with hemofiltration.⁴ We now describe a patient who became acutely ill during a hemofiltration procedure that was associated with a markedly elevated plasma level of tumor necrosis factor. A 21-year-old woman with end-stage renal disease due to interstitial nephritis had received over 650 uneventful treatments using post-dilutional hemofiltration over the previous five years. Two weeks earlier,…