1Enas AE Daef, 2Farouk Alsayed Hassanein, 2Ekram Aly Hashem, 3Madeha Mhrous Zakhary and 2Ehab Mohamed Ahmed.
1Microbiology & Immunology, 2Pediatrics and 3Biochemistry Departments, Faculty of Medicine, Assiut University.
To precise the immune state in children with end stage renal disease (ESRD) on regular hemodialysis (HD) and the possible impact of some micronutrients supplementation, we studied 40 patients (26 males and 14 females, aged from 6 to 13 years), and 10 apparently healthy children with matchable age and sex as controls. All the patients and controls were subjected to the following investigations: complete blood picture, plasma levels of vitamin C (Vit. C) and vitamin B6 (Vit. B6), as well as serum levels of zinc. In addition, tests to study the immunologic state were done for cases and controls including, absolute lymphocytic count (ALC), percentages of total T lymphocytes (CD3) and their subsets including, T-helper (CD4)+ and T-suppressor (CD8)+ cells, serum levels of soluble interleukin-2 receptors (sIL-2R), certain complement components (C3 and C4), lymphoblast transformation index (LTI), as well as the purine nucleotides metabolizing enzymes in plasma including, adenosine deaminase (ADA), and 5’-nucleotidase (5’-NT). After initial evaluation of all the aforementioned parameters, the studied cases were classified randomly into 4 groups, each included 10 patients, and each group was subjected to a specific regimen of supplementation (Vit. C, Vit. B6, zinc or all the 3 nutrients). A follow up study for all the studied parameters was done for 5 patients from each group at 8 weeks and at 16 weeks. Alterations in the studied parameters, relation between these alterations and duration of the disease, effect of supplementation with Vit. C, Vit. B6, and zinc (singly or combined) on all the studied parameters at 8 weeks and at 16 weeks are detailed. We conclude that, several alterations in cell mediated immune response were found in children with ESRD on chronic HD. Also, those children showed low levels of Vit. C, Vit. B6, and zinc which were worse with longer duration of the disease. Supplementation with these nutrients led to some improvement in cellular immunity. The best results were obtained when combined supplementation with the 3 nutrients was given. Therefore, we recommend to give combined supplementation with the three nutrients to uremic patients.