Assessment of Neutrophil Activation in Children with Chronic Kidney Disease Stage 5 on Hemodialysis: Effect of a Single Procedure

Abstract Background Hemodialysis (HD) process can trigger inflammation and induce cytokines activation. Neutrophils extrude neutrophil extracellular traps (NETs) which are extracellular chromatin containing a variety of granular proteins that have been implicated in infection, as well as vascular inflammation and occlusion. Objective To assess the effect of a single HD session on the level of circulating NETs 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 receiving 3 hours HD session 3 times per week using low flux polysulfone dialyzer and 26 age and sex matched children as controls. Patients with the following medical conditions were excluded: failed renal graft, active infection, autoimmune disease, active thrombosis, diabetes mellitus, malignancy, cardiovascular disease like (infective endocarditis, vegetation and intracardiac mass) and patients on immunosuppressants. Complete blood cell (CBC), C-reactive protein (CRP) and serum NETs measured by enzyme-linked immunosorbent assay were done for all cases pre- and post-dialysis as well as the control group. Results The mean±SD age of the patient was 12.2±2.8 years. They were 16 males (61.5%) and 10 females (38.5%). The mean age of the controls was 10.9±2.7 years. They were 13 males (50%) and 13 females (50%). There was significantly elevated pre-HD (Median= 535.95ng/L, IQR= 519.6ng/L) and post-HD (Median=1310.5ng/L, IQR=916.4ng/L) serum NETs compared to its level (Median=149.1ng/L, IQR=69.7ng/L) in controls (p