title: Elastase, α1-proteinase inhibitor, and interleukin-8 in pre-dialyzed and hemodialyzed patients with chronic kidney disease.
abstract: BACKGROUND
  Neutrophil elastase in complex with α(1) -proteinase inhibitor (NE-α(1) PI) and interleukin (IL)-8 may serve as indicators of neutrophil activation and inflammatory stage. The aim of the study was to evaluate NE-α(1) PI, α(1)-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-α(1) PI, α(1)-PI, and IL-8 concentrations between the HD1 and HD2 patients. The levels of NE-α(1) PI 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-α(1) PI (P < 0.05) and α(1)-PI (P < 0.01) were obtained in the adults during the course of HD. Increased NE-α(1) PI was positively correlated with α(1)-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-α(1) PI and α(1)-PI in adults, but not in children/young adults. NE-α(1) PI seems to be a much better indicator of an inflammatory state in CKD patients than free α(1)-PI or IL-8.
authors.affiliation: 3rd Department and Clinics of Pediatrics, Immunology and Rheumatology of Developmental Age, Medical University of Wroclaw, Wroclaw, Poland. bozenamd@poczta.onet.pl
authors.forename: Bozena
authors.initials: B
authors.lastname: Polańska
authors.forename: Daria
authors.initials: D
authors.lastname: Augustyniak
authors.forename: Irena
authors.initials: I
authors.lastname: Makulska
authors.forename: Maria
authors.initials: M
authors.lastname: Niemczuk
authors.forename: Danuta
authors.initials: D
authors.lastname: Zwolińska
authors.forename: Adam
authors.initials: A
authors.lastname: Jankowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D016209:Interleukin-8 / Q000097:blood*; D007677:Kidney Function Tests; D019272:Leukocyte Elastase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000628:therapy; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D055815:Young Adult; D000515:alpha 1-Antitrypsin / Q000097:blood*
chemical_list: D018836:Inflammation Mediators; D016209:Interleukin-8; D000515:alpha 1-Antitrypsin; D019272:Leukocyte Elastase