Essay on The Importance of Human Touching

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dialysis

High-flux and Low-flux Dialysis Membranes and Levels of Intercellular Adhesion Molecule-1 and Vascular Cell Adhesion Molecule-1 in Children With Chronic Kidney Failure
Happy K Sawires,1 Waleed A Mohamed,2 Mona F Schaalan3

1Department of Pediatrics, Cairo University, Cairo, Egypt 2Department of Chemistry, Cairo University, Cairo, Egypt 3Department of Pharmacy, Misr International University, Cairo, Egypt Keywords. dialysis membranes, intercellular adhesion molecule-1, vascular cell adhesion molecule-1

Introduction. During hemodialysis, the expression of different adhesion molecules changes, thus serving as markers of biocompatibility of dialysis membranes. Our aim was to investigate whether low-flux and high-flux dialysis membranes have different effects on the concentration of adhesion molecules and their association with leukocytes and pro-inflammatory cytokines. Materials and Methods. We enrolled 80 pediatric patients on hemodialysis. Baseline levels of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were measured. The patients were classified into 2 groups to use either low-flux filters or high-flux filters for 3 months. At the end of the 3 months, predialysis samples were obtained for measurement of ICAM-1, VCAM-1, TNF-α and interleukin-1. Post-dialysis samples were collected for measurement of CBC, ICAM-1, VCAM-1, TNF-α, and interleukin-1. Forty volunteers were involved as a control group. Results. Both TNF- α and IL-1 were higher in the patients compared to the control group (P < .001). Compared to the control group, there was a significant increase in ICAM-1 and VCAM-1 (P < .001) in both groups predialysis and postdialysis. The postdialysis increments of ICAM-1 with the high-flux membranes were significantly less compared to the low-flux membranes (P < .001). Serum ICAM-1 and VCAM-1 significantly correlated with TNF-α and interleukin-1 in all groups. Conclusions. The postdialysis increments of the adhesion molecules are due to the effect of dialysis membranes, which is less with the use of high-flux filters.
IJKD 2012;6:366-72 www.ijkd.org

original Paper

INTRODUCTION An effective immune response depends on leukocytes migration to the site of inflammation. The membrane bound forms of selectins (E-selectin, L-selectin, and P-selectin) and molecules of the immunoglobulin superfamily, such as intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), take part in a process of leukocyte migration called the “adhesion

cascade. 1,2” In vitro studies have suggested that targeting interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) can be used to regulate ICAM-1 and VCAM-1.3 During hemodialysis, the leukocytes in the circulation are activated and a number of proinflammatory cytokines are secreted, including IL-1 and TNF-α.4 The expression of different adhesion molecules changes during hemodialysis sessions,

366

Iranian Journal of Kidney Diseases | Volume 6 | Number 5 | September 2012

High-flux and Low-flux Dialysis Membranes and Immunoglobulin Superfamily—Sawires et al thus serving as markers of biocompatibility of dialysis membranes. 5 However, investigation of soluble adhesion molecules shed proteolytically from cells into the circulation has given contradictory results in hemodialysis patients.6 In this study, we evaluated serum levels of the two soluble adhesion molecules (ICAM-1 and VCAM-1) and two other pro-inflammatory cytokines (TNF-α and IL-1) in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. Our aim was to investigate whether low-flux and high-flux dialysis membranes have different effects on the concentration of these adhesion molecules and whether there is any relationship between circulating adhesion levels and leukocytes or proinflammatory cytokines. and heparin for a 3 months’ duration. Patients in the 2nd group used high-flux polysulfone filters (Fresinius F40 or F50,
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