Interleukins 8 and 10, and tumor n ecrosis factor alpha and its type I soluble receptor in hemodialysis children with chronic renal failure: relationship to growth and inflammatory markers

Chronic renal failure [CRF] is envisioned as an immunodeficiency state despite the deregulated release of several cytokines and their soluble receptor. TNF-alpha, lL-8 and lL-10 were particularly implicated in priming and desensitization of human polymorphonuclear cells. We hypothesized that imbalance between the proand anti-inflammatory cytokines using inflammatory biomarker as indictors would elucidate underlying causes of such immunodeficiency in a milieu with reportedly apparent constitutively activated immune cells with possible impact on growth. Plasma from 26 chronic renal failure children on regular hemodialysis [HD] and 26 age-matched healthy control individuals were investigated by using ELISA assays for TNF-alpha, sTNF-alpha-R1, lL-8 and lL-10 that were subjected to analysis of variance and multiple regression analysis for correlation with each other and with creactive protein [CRP] and procalcitonin [measured by agglutination and RIA, respectively] as inflammatory markers, and weight-for-age, height-for-age and weight-for-height percentile as growth indices. Plasma levels of CRP, procalcitonin, TNF-alpha, sTNF-alpha-R1 and lL-10 showed significant difference comparing patients to controls, without a significant difference due to HD session per se. Similar difference was noticed for lL-8 although it was significantly increased after HD session. The molar ratio of sTNF-alpha-R1/TNF-alpha was significantly increased in patients than controls only after HD session. At the end of HD session, there was a strong positive correlation between all parameters except IL-10. The cytokines levels correlated stronger with procalcitonin than CRP. Similar correlations were observed before HD session for all parameters except for lL-8 that correlated positively only with sTNFR1 and procalcitonin. The growth indices did not show correlation with the studied biomarkers except for CRP [before and after HD session] and IL-10 [before session only] that showed positive correlation with weight-for-height percentile as a chronic malnutrition marker. Increased secretion of TNFalpha and lL-8 and decreased IL-10 indicated that Immune cells are in an activated state confirmed by the increased inflammatory biomarkers, a state possibly potentiated‘ by the increased sTNF-alpha-R1 in the light of its possible conservatory function on TNFalpha. These results show possible exhaustion of immune cells and long term desensitization in presence of marked increase in proinflammatory inducers and absence of counteracting antiinflammatory effector role in CRF pediatric patients on HD. This raises the importance of intervention approaches to correct such imbalance in favor of IL-10 for the-benefit of growth