Effect of Metabolic Acidosis on Immunoregulation in Prevalent Hemodialysis Patients

Abstract

The principal function of immune system is the protection from invading pathogens and microorganisms by destroying infected cells and minimizing collateral tissue damage. Cytokine secretion represents the communication that determine the type, quality, amplitude, duration, and outcome of the immune response, and the different cytokines represent the words that articulate the orders and functions to be executed by immune cells. Inflammation is common among patients with ESRD. A high percentage of HD patients show dysregulation of markers of inflammation indicated by increased levels of various pro inflammatory cytokines and elevated CRP level which has adverse clinical effects as cardiovascular mortality, malnutrition and other undesirable outcomes. Objective: to evaluate the relationship between IL-10 and serum bicarbonate and metabolic acidosis in prevalent hemodialysis patients and evaluate the effect of correction of metabolic acidosis on IL10 levels. Patients and Methods: Type of Study: prospective case control study. Study Setting: The study was conducted at Ain Shams University hospital hemodialysis unit. Sample Size: 40 patients with ESRD on regular HD and 20 healthy control. Study Population: Maintenance hemodialysis patients Results: The results suggested that serum IL-10 level was significantly higher in chronic HD patients than healthy subjects and this is compatible with the idea that higher levels of IL‑10 are needed in HD patients to limit their strong inflammatory activation associated with uremia and the dialysis technique. There was no significant differences in baseline IL-10 levels noticed between patients with different causes of ESRD. This study also showed negative correlation between IL-10 and serum bicarbonate levels. We also found that there was significant positive correlation between baseline levels of IL-10 and CRP which may be because of dialysis inadequacy that is associated with chronic inflammatory state resulting in high CRP levels. Conclusion: The incidence and prevalence of ESRD have risen dramatically which may be due to the increasing prevalence of diabetes and hypertension. Although regular hemodialysis decreases levels of mortality in these patients, it is still considered a condition associated with inflammation. The current study revealed high IL-10 levels among HD patients who had metabolic acidosis, we found that IL-10 level decreased after acidosis correction in these population. Further research needs to be done to reveal beneficial effects of these finding.