Heat-Shock Protein 27 kinetics in end stage renal disease patients

Abstract

Introduction and Aims: The Heat Shock Proteins (HSP)are a group of proteins with a functional connection, whose expression is increased when cells are exposed to high temperatures or other physicochemical stimuli (infection, exercise, oxidative stress, cytokine production) situations that usually accompany the hemodialysis (HD) sessions with possible effects on cell-endothelial integrity. Purpose of the study was to evaluate the kinetics of the HSP and cytokines during HD sessions in relation to particular characteristics (HD modality, dialyzers, membranes), in order to evaluate possible differences in the hemodialysis population at a specific time period and to determine possible involvement of endothelial dysfunction. Methods: For this purpose in 20 stable HD patients blood and dialysate samples were collected before and after the session of HD , by measuring the levels of IL-1, IL-1 b , IL-2, IL-5, IL-6, IL-8, IL-10, TNF-a, HSP-27, caspase 3 by Luminex technology . These data were evaluated in conjunction with the values Hb, Hct, ferritin, PTH, CRP and albumin. Results: The use of low or highflux membrane did not significantly affect the kinetics of HSP and cytokines. In dialysate HSP-27 was slightly detectable while all other cytokines not at all. The use of natural polymers as membrane materials increased levels of HSP-27, something that observed during classic HD and not during on line Hemodiafiltration. The levels of HSP-27 had prognostic value for Hb (r =- 0.555), parathyroid hormone (r = 0,873) and the value of albumin (r=0,510). Conclusions: Our data provide further evidence for the hypothesis of an autoimmune induction of early inflammatory arteriosclerotic changes. Further studies are necessary to determine whether HSP-27 has diagnostic and prognostic value in patients on chronic hemodialysis.