Effects of dialysis therapies on circulating levels of endothelial markers after kidney transplant in children: focus on positive aspect of peritoneal dialysis

Pediatric kidney failure carries high cardiovascular risk. Kidney transplantation is the preferred therapy, yet residual endothelial dysfunction contributes to post-transplant morbidity. The current study determines whether pre-transplant hemodialysis versus peritoneal dialysis affects post-transplant levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), P-selectin, and nitric oxide (NO) in pediatric kidney transplant recipients.

In a cross-sectional study, we assessed 53 children 6–24 months after kidney transplantation. Fourteen had received peritoneal dialysis and 39 hemodialysis pre-transplant. Serum sICAM-1, sVCAM-1, and P-selectin were measured using a Luminex-based assay and NO by chemiluminescence.

Baseline demographic characteristics were similar between groups. Peritoneal dialysis was associated with lower sICAM-1 (p= 0.028) and sVCAM-1 (p= 0.006) and higher NO (p< 0.001), whereas P-selectin did not differ (p= 0.308). sICAM-1 correlated positively with P-selectin (r= 0.286, p= 0.038) and dialysis duration (r= 0.303, p= 0.028) and inversely with glomerular filtration rate (r=−0.328, p= 0.016). sVCAM-1 correlated positively with dialysis exposure time (r= 0.340, p= 0.013) and negatively with NO (r=−0.393, p= 0.004). Dialysis type and duration predicted sVCAM-1 (R²=0.199), dialysis exposure time-predicted sICAM-1 (R²=0.203), and modality-predicted NO (R²=0.252).

In pediatric kidney transplant recipients, pre-transplant peritoneal dialysis is associated with reduced endothelial activation and enhanced NO bioavailability compared with hemodialysis, suggesting a vascular benefit that could inform dialysis selection prior to transplantation.