Modality matters: Effect of dialysis modality on soluble intercellular adhesion molecule-1 in children on regular hemodialysis

BACKGROUND Intercellular adhesion molecule-1 (ICAM-1) plays a key role in mediating leukocyte adhesion and endothelial injury. Elevated circulating levels of soluble ICAM-1 (sICAM-1) in patients undergoing hemodialysis (HD) have been linked to a higher incidence of cardiovascular complications. AIM To evaluate the impact of dialysis modality and membrane performance on post-dialysis sICAM-1 levels in children undergoing maintenance HD. METHODS This study included 26 children on low-flux HD for at least 3 months and 26 sex-matched and age-matched healthy controls. Patients were shifted to high-flux HD for 3 months, then subsequently to post-dilutional online hemodiafiltration (OL-HDF) for additional 3 months. At the end of each study phase, blood samples were obtained before and after a mid-week HD session for sICAM-1 measurement. To account for hemoconcentration, post-session ICAM-1 were hematocrit-adjusted using van Beaumont’s formula yielding corrected ICAM-1 (cICAM-1). RESULTS Circulating post-dialysis cICAM-1 levels increased significantly after low-flux HD compared with the corresponding pre-dialysis levels (P = 0.002), and were also significantly higher than those of the control group (P < 0.001). Following conversion to high-flux HD, post-dialysis cICAM-1 concentrations decreased significantly compared to pre-dialysis values (P < 0.001), although they remained elevated compared to controls (P = 0.026). In contrast, OL-HDF was associated with a substantial decline in post-session cICAM-1 levels (P < 0.001), yielding values comparable to those observed in the control group (P = 0.898). CONCLUSION Children on maintenance HD exhibit elevated sICAM-1 levels. Our findings suggest that higher-efficiency dialysis modalities, such as OL-HDF, may attenuate dialysis-related inflammation and endothelial activation in these patients.