Abstract: TH-PO007
The Complement System and Hemodialysis: Activity of the Lectin Pathway
Session Information
- Complement Your Knowledge of Kidney Disease
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 601 Standard Hemodialysis for ESRD
Authors
- De laval, Philip, Uppsala university, Uppsala, Sweden
- Pilely, Katrine, Rigshospitalet, Copenhagen, Denmark
- Garred, Peter, Rigshospitalet, Copenhagen, Denmark
- Nilsson, Bo, Uppsala university, Uppsala, Sweden
- Fellstrom, Bengt C., Uppsala university, Uppsala, Sweden
- Soveri, Inga, Uppsala university, Uppsala, Sweden
Background
Complement activation occurring during hemodialysis (HD) has been put forward as a driving force for inflammation in HD patients, but the importance of the lectin complement pathway in HD is largely unknown.
Aim: To quantify complement activity through the lectin pathway in contemporary HD.
Methods
Blood was sampled from 20 consecutive HD-patients before, at 30, 60, 120, 180 and 240 minutes and after the prescribed HD-session using either polysulphone or polyarylethersulfone/polyamide/polyvinylpyrrolidone dialyzers. Enzyme-linked immunosorbent assays were used to quantify plasma concentration of the lectin pathway initiator molecules, ficolin -1, -2, -3, mannose-binding lectin (MBL), lectin pathway regulator MAP-1 and enzyme MASP-3 as well as the soluble form of the terminal complement complex, sC5b-9.
Results
Plasma concentrations of ficolin-2, MAP-1 and MASP-3 decreased significantly after 30 minutes and remained low for the rest of the HD session. MBL decreased after 30 minutes and returned to baseline levels after 2 hours, while no change was seen for ficolin-1 and ficolin-3. Concentrations of sC5b-9 increased after 30 minutes and remained elevated for the rest of the HD session.
Conclusion
Complement activation occurs during HD as indicated by increase in sC5b-9. LP complement factors decrease, in particular ficolin-2 which is almost depleted, likely due to dialyzer adsorption and/or consumption. Further studies are needed to investigate the long-term kinetics and half-life of the changes and to examine their clinical impact.
Plasma Concentration of lectin pathway complement factors during hemodialysis
| Factor | Pre-dialysis | 1 h | p (Pre vs 1 h) | 4 h | p (Pre vs 4 h) |
| Ficolin-1 (ng/ml) | 271 (162 - 1200) | 317 (142 - 1200) | 0.952 | 267 (154 - 1200) | 0.338 |
| Ficolin-2 (µg/ml) | 4.85 (1.44 - 12.5) | 0.964 (0.246 - 5.1) | < 0.001 | 0.712 (0.156 - 2.94) | < 0.001 |
| Ficolin-3 (µg/ml) | 26 (13 - 45.9) | 22.2 (14.5 - 35.2) | 0.312 | 27.2 (12.5 - 55) | 0.465 |
| MBL (ng/ml) | 314 (11.1 - 4348) | 269 (11.4 - 3991) | 0.007 | 284 (16.2 - 2629) | 0.113 |
| MAP-1 (ng/ml) | 259 (143 - 524) | 176 (70.7 - 321) | < 0.001 | 190 (99.5 - 388) | 0.005 |
| MASP-3 (ng/ml) | 9499 (4737 - 10000) | 3048 (1608 - 5749) | < 0.001 | 4772 (1743 - 10000) | 0.008 |
| sC5b-9 (AU/ml) | 0.502 (0.317 - 0.967) | 0.74 (0.442 - 2.41) | < 0.001 | 0.705 (0.446 - 1.37) | 0.001 |
Data presented as median (range).