Elastase, α1-proteinase inhibitor, and interleukin-8 in pre-dialyzed and hemodialyzed patients with chronic kidney disease

• Published in: Pediatrics international Vol. 52; no. 5; pp. 735 - 743
• Main Authors: Polańska, Bożena, Augustyniak, Daria, Makulska, Irena, Niemczuk, Maria, Zwolińska, Danuta, Jankowski, Adam
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.10.2010
• Subjects: Adolescent; Adult; Age Factors; alpha 1-Antitrypsin - blood; Case-Control Studies; Child; chronic kidney disease; elastase; Enzyme-Linked Immunosorbent Assay; Female; hemodialysis; Humans; Inflammation Mediators - blood; interleukin-8; Interleukin-8 - blood; Kidney Function Tests; Leukocyte Elastase - blood; Male; Middle Aged; Prognosis; Reference Values; Renal Dialysis - methods; Renal Dialysis - statistics & numerical data; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - therapy; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Statistics, Nonparametric; Young Adult; α1-proteinase inhibitor
• ISSN: 1328-8067; 1442-200X; 1442-200X
• DOI: 10.1111/j.1442-200X.2010.03162.x

Background:  Neutrophil elastase in complex with α1‐proteinase inhibitor (NE‐α1PI) and interleukin (IL)‐8 may serve as indicators of neutrophil activation and inflammatory stage. The aim of the study was to evaluate NE‐α1PI, α1‐PI, and IL‐8 levels in the blood of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) or conservatively treated (CT). The influence of a single HD session on the investigated parameters was also assessed. Methods:  Blood samples were obtained from two groups of hemodialyzed patients (children/young adults [group HD1, n= 8] and adults [group HD2, n= 13]), as well as 13 CT patients and a group of healthy subjects. The proteins were measured using enzyme‐linked immunosorbent assay or radial immunodiffusion. Results:  There were no significant differences in NE‐α1PI, α1‐PI, and IL‐8 concentrations between the HD1 and HD2 patients. The levels of NE‐α1PI were considerably higher than normal in both groups of HD patients (before and after the HD session) and in the CT patients. Higher titers of NE‐α1PI (P < 0.05) and α1‐PI (P < 0.01) were obtained in the adults during the course of HD. Increased NE‐α1PI was positively correlated with α1‐PI. The serum concentration of IL‐8 was significantly higher in the HD2 patients before and after dialysis than in the controls. Conclusions:  The data indicate that in CKD patients, neutrophils are highly activated both in the pre‐dialyzed period and on regular HD. Contact with the dialysis membrane during HD causes a significant increase in blood NE‐α1PI and α1‐PI in adults, but not in children/young adults. NE‐α1PI seems to be a much better indicator of an inflammatory state in CKD patients than free α1‐PI or IL‐8.