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Abstract: TH-PO007

The Complement System and Hemodialysis: Activity of the Lectin Pathway

Session Information

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
FactorPre-dialysis1 hp (Pre vs 1 h)4 hp (Pre vs 4 h)
Ficolin-1 (ng/ml)271 (162 - 1200)317 (142 - 1200)0.952267 (154 - 1200)0.338
Ficolin-2 (µg/ml)4.85 (1.44 - 12.5)0.964 (0.246 - 5.1)< 0.0010.712 (0.156 - 2.94)< 0.001
Ficolin-3 (µg/ml)26 (13 - 45.9)22.2 (14.5 - 35.2)0.31227.2 (12.5 - 55)0.465
MBL (ng/ml)314 (11.1 - 4348)269 (11.4 - 3991)0.007284 (16.2 - 2629)0.113
MAP-1 (ng/ml)259 (143 - 524)176 (70.7 - 321)< 0.001190 (99.5 - 388)0.005
MASP-3 (ng/ml)9499 (4737 - 10000)3048 (1608 - 5749)< 0.0014772 (1743 - 10000)0.008
sC5b-9 (AU/ml)0.502 (0.317 - 0.967)0.74 (0.442 - 2.41)< 0.0010.705 (0.446 - 1.37)0.001

Data presented as median (range).