title: Neutrophil activation and resistance to recombinant human erythropoietin therapy in hemodialysis patients.
abstract: OBJECTIVE
  The aim of this work was to evaluate the neutrophil activation state in chronic kidney disease (CKD) patients under hemodialysis, and its linkage with resistance to recombinant human erythropoietin (rhEPO) therapy.
  
  
  METHODS
  We studied 63 CKD patients under hemodialysis and rhEPO treatment (32 responders and 31 non-responders to rhEPO therapy). In 20 of the CKD patients (10 responders and 10 non-responders to rhEPO therapy), blood samples were also collected immediately after dialysis. Twenty-six healthy volunteers were included in a control group. Hemoglobin levels, total and differential leukocyte counts, and circulating levels of C-reactive protein (CRP), elastase and lactoferrin were measured in all patients and controls.
  
  
  RESULTS
  Compared with controls, CKD patients presented with significantly higher CRP, neutrophil and elastase levels. When we compared the 2 groups of patients, we found that non-responders presented statistically significantly higher elastase plasma levels. A positive significant correlation was found between elastase levels and weekly rhEPO dose and CRP serum levels. After the hemodialysis procedure, a statistically significant rise in elastase, lactoferrin and, elastase/neutrophil and lactoferrin/neutrophil ratios were found.
  
  
  CONCLUSIONS
  Our data show that CKD patients under hemodialysis present higher elastase levels (particularly in non-responding patients), which could be related to the rise in neutrophils, and to be part of the enhanced inflammatory process found in these patients.
authors.affiliation: Faculdade Farmácia, Serviço de Bioquímica, Universidade do Porto, Porto Portugal.
authors.forename: Elísio
authors.initials: E
authors.lastname: Costa
authors.forename: Susana
authors.initials: S
authors.lastname: Rocha
authors.forename: Petronila
authors.initials: P
authors.lastname: Rocha-Pereira
authors.forename: Henrique
authors.initials: H
authors.lastname: Nascimento
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Castro
authors.forename: Vasco
authors.initials: V
authors.lastname: Miranda
authors.forename: Maria do Sameiro
authors.initials: Mdo S
authors.lastname: Faria
authors.forename: Alfredo
authors.initials: A
authors.lastname: Loureiro
authors.forename: Alexandre
authors.initials: A
authors.lastname: Quintanilha
authors.forename: Luís
authors.initials: L
authors.lastname: Belo
authors.forename: Alice
authors.initials: A
authors.lastname: Santos-Silva
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000096:biosynthesis; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation; D007781:Lactoferrin / Q000097:blood; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009504:Neutrophils / Q000166:cytology* / Q000378:metabolism; D010196:Pancreatic Elastase / Q000097:blood; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D002097:C-Reactive Protein; D007781:Lactoferrin; D010196:Pancreatic Elastase