The activation of complement system in different types of renal replacement therapy.

The complement cascade is a part of innate immune system that responds rapidly to defend the host against invading microorganisms and complete the action of immune cells. The activation of the complement system leads to increased inflammatory response, fibrosis of tubulointestinal tissue and progression of chronic kidney disease (CKD). The purpose of this study was to determine whether the type of renal replacement therapy has an effect on activation of the complement system. The study included 79 patients with CKD stages 4 - 5 according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines on conservative treatment (CKD4-5) (n = 28), on peritoneal dialysis (PD) (n = 21) and undergoing chronic haemodialysis (HD) (n = 30). The concentrations of complement components C3a, C5a and C5b-9 were determined in plasma using the ELISA method. The highest concentration of C3a was found in PD group and differed significantly from HD group, both before and after haemodialysis treatment and CKD4-5 patients (P = 0.00001). The C5a concentration in HD patients was significantly higher than in PD patients and CKD4-5 group (P = 0.0001). The C5a and C5b-9 concentrations significantly increased during the haemodialysis session (P = 0.027 and P = 0.01, respectively). The values of C5b-9 observed in PD and CKD4-5 groups were significantly lower, than in HD patients (P = 0.0005). In HD patients the negative correlations were found between the time of haemodialysis treatment and C5b-9 concentration, both before and after haemodialysis session (Rs = -0.436, P = 0.016 and Rs = -0.365, P = 0.046, respectively). The type of renal replacement therapy influences the complement activation, which is the most intense during the haemodialysis treatment and correlates negatively with the haemodialysis vintage. The promising therapeutic intervention may be an improvement of HD biocompatibility.

Bone Metabolism Parameters in Hemodialysis Patients With Chronic Kidney Disease and in Patients After Kidney Transplantation.

Chronic kidney disease adversely affects the structure and metabolism of bone tissue, which may be a result of disturbed biochemical processes in adipose tissue. Renal replacement therapy is a life-saving therapy but it does not restore all metabolic functions and sometimes even escalates some disturbances. The study included 126 subjects: 47 hemodialysis patients (HD), 56 patients after renal transplantation (Tx) and 23 healthy controls (K). Bone density at the femoral neck (FN) and lumbar spine (LS), as well as body composition (adipose tissue content and lean body mass) were measured in each patient using the DXA method. In addition, serum concentrations of glucose, calcium, phosphorus, parathormone, FGF23, Klotho, osteocalcin, leptin, adiponectin and 1,25-dihydroxyvitamin D3 were measured. We observed significantly higher concentrations of leptin, FGF23 and Klotho proteins in the HD patients (77.2±48.1 ng/ml, 54.7±12.4 pg/ml, 420.6±303.8 ng/ml, respectively) and the Tx group (33.2±26.5 ng/ml; 179.8±383.9 pg/ml; 585.4±565.7, respectively) compared to the control group (24.4±24.6 ng/ml, 43.3±37.3 pg/ml, 280.5±376.0 ng/ml). Significantly lower bone density at FN was observed in the HD and Tx patients in comparison to the controls and in the HD patients compared to the Tx group. There were no significant differences in body mass composition between the studied groups. The results of this study indicate that both hemodialysis and transplantation are associated with increased serum concentrations of leptin, FGF23 and Klotho proteins, as well as lower bone density at femoral neck.

Does glucose in dialysis fluid protect erythrocytes in patients with chronic renal failure?

BACKGROUND/AIMS: The aim of this study was to assess the multifaceted influence of glucose present in dialyzing fluid on erythrocytes of patients with chronic renal failure (CRF) undergoing regular hemodialysis. METHODS: A group of 44 subjects with CRF undergoing regular hemodialysis was studied. Two tests were used: osmotic fragility and resistance to the hemolytic agent saponin. The total content of isoprostane 8-iso-prostaglandin F2alpha type III (8-iPF2alpha-III) in plasma and erythrocyte's membrane were determined by the ELISA method. RESULTS: The presence of glucose in the dialysate is associated with lower intravascular hemolysis markers and high total 8-iPF2alpha-III concentrations in plasma. CONCLUSION: The presence of glucose in dialyzing fluid could protect erythrocytes. It limits hemolysis in patients with CRF, but, on the other hand, increases the oxidative processes. This kind of treatment along with other therapeutic intervention such as administration of antioxidants (e.g. alpha-tocopherol, ascorbic acid, N-acetylcysteine) could improve the condition of erythrocytes and outcome in CRF.