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NDT Advance Access originally published online on August 8, 2006
Nephrology Dialysis Transplantation 2006 21(11):3196-3201; doi:10.1093/ndt/gfl359
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Polymorphonuclear leucocyte priming in long intermittent nocturnal haemodialysis patients—is melatonin a player?

Ronit Geron1, Revital Shurtz-Swirski2, Shifra Sela2,3, Yevgeny Gurevitch1, Tatiana Tanasijtchouk1, Zila Shenn Orr4, Galina Shkolnik1, Olga Tanhilevski1 and Batya Kristal1,3

1Nephrology and Hypertension Department, 2Eliachar Research Laboratory, Western Galilee Hospital, Nahariya, 3Bruce Rappaport Faculty of Medicine, Technion and 4Endocrinology Lab, Rambam Hospital, Haifa, Israel

Correspondence and offprint request to: Ronit Geron, MD, Department of Nephrology and Hypertension, Western Galilee Hospital, Nahariya 22100, Israel. Email: ronit.geron{at}naharia.health.gov.il

Background. The relationships between sleep quality, melatonin circadian rhythm and polymorphonuclear leucocyte (PMNL) priming during the night of dialysis treatment compared with a night without dialysis were studied in a group of nocturnal haemodialysis (HD) patients.

Methods. Twenty-eight long intermittent nocturnal HD patients were included. Sleep quality was assessed by a questionnaire and wrist actigraphy. Plasma melatonin levels were assayed every 2 h, from 9 p.m. to 5 a.m. PMNL priming was assessed by the rate of superoxide release from separated PMNLs at 9 p.m. and 5 a.m., on a night of dialysis and a night with sleepover in the dialysis unit without being dialysed.

Results. Melatonin levels increased similarly during a night with and without dialysis, reaching peak level at 5 a.m. Most (73%) of the patients had severe sleep disturbances. A significant negative correlation was found between the sleep quality score, the rate of superoxide release from separated PMNLs and melatonin levels. While during a night without dialysis a significant reduction of the rate of superoxide release was found at 5 a.m. (compared with 9 p.m.), no significant reduction was observed when the patients were dialysed. Patients with flat melatonin curves, with <10 pg/ml, showed a faster rate of superoxide release than those with higher levels.

Conclusions. The nocturnal HD process does not affect plasma melatonin levels or rhythms, suggesting that melatonin is not dialysed. Higher endogenous melatonin levels are associated with better sleep and lower PMNL priming. The lower PMNL priming in patients with higher plasma melatonin levels suggests that melatonin overrides the oxidative burden induced by the dialysis process.

Keywords: long intermittent nocturnal hemodialysis; melatonin; oxidative stress; PMNL priming


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[Abstract] [Full Text] [PDF]


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