Effect of a Hemodialysis Session on Intercellular Adhesion Molecule-1 (ICAM-1) in Children with Chronic Kidney Disease Stage 5 on Regular Hemodialysis

Abstract

Abstract Background During hemodialysis (HD) session leukocytes are activated and a number of proinflammatory cytokines and adhesion molecules are secreted. One of these adhesion molecules is intercellular adhesion molecule-1 (ICAM-1). ICAM-1 is a cell surface glycoprotein adhesion receptor responsible for regulating leukocyte recruitment from the circulation to sites of inflammation. It is incriminated in the endothelial cell injury in HD patients making them at risk of cardiovascular complications. Objective To assess the effect of a single HD session on the level of circulating ICAM-1 in children with chronic kidney disease stage 5 (CKD-5) on regular HD treatment. Methods This is a cross sectional study done at Pediatric Dialysis Unit (PDU), Children’s Hospital, Ain Shams University during the period from April 2023 to July 2023. It included 26 CKD-5 cases and 26 age and sex matched children as controls. CBC, CRP and serum ICAM-1 (ELISA) were done for all cases pre-HD. CBC and serum ICAM-1 were repeated for all patients post-HD. CBC, CRP and serum ICAM-1 were also done for controls. Results This study comprised 26 cases with mean age of 12.2±2.8 years. They were 16 males (61.5%) and 10 females (38.5%). All cases were receiving 3 hours HD session 3 times per week using low flux polysulfone dialyzer. It also included 26 controls with mean age of 10.9±2.7 years. They were 13 males (50%) and 13 females (50%). Cases and controls were age and sex matched. Our results revealed statistical evidence of significantly elevated pre-HD (Median= 676.6ng/L, IQR= 932.1ng/L) and post-HD (Median= 1749.5ng/L, IQR= 1812.5ng/L) serum ICAM-1 compared to its level (174.6 ±55.5ng/L) in controls (p < 0.001 for both). There was also statistical evidence of significantly higherlevel of post-HD serum ICAM-1 than its pre-HD one (p = 0.001). This study did not show any statistical evidence of significant differences in ICAM-1 levels regarding gender, dialyzer surface area, pump blood flow rate and the presence of hypertension. It did not also reveal any statistical evidence of significant correlations between ICAM1 and any of the studied variables including age, duration of HD and the parameters of CBC especially TLC, ANC & LC. Conclusion children with CKD-5 on regular HD had higher basal levels of serum ICAM- 1 than normal controls. These levels were further increased after HD session using low flux polysulfone membrane.