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

doi:10.5409/wjcp.120090

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Pediatr. Sep 9, 2026; 15(3): 120090
Published online Sep 9, 2026. doi: 10.5409/wjcp.120090

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

Mohammed F Kasem, Ragia M Said, Doaa R Dahshan, Samar H Elhadedy, Noha R Mohammed, Noha U Hashem

Mohammed F Kasem, Ragia M Said, Noha U Hashem, Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 1181, Egypt

Doaa R Dahshan, Department of Pediatrics, Damietta Specialized Hospital, Damietta 34512, Egypt

Samar H Elhadedy, Department of Pediatrics, Dekernes General Hospital, Dekernes 35511, Egypt

Noha R Mohammed, Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo 1181, Egypt

Co-corresponding authors: Ragia M Said and Noha U Hashem.

Author contributions: Kasem MF, Said RM, and Hashem NU formulated the research study design; Kasem MF and Hashem NU assisted in performing statistical analysis; Dahshan DR and Elhadedy SH performed the research work and collected data under the supervision of Kasem MF, Said RM, and Hashem NU; Mohammed NR supervised the laboratory analysis of the collected samples; Said RM and Hashem NU contributed equally to this manuscript and are co-corresponding authors. All authors contributed to drafting the article, revised the manuscript, and approved the final manuscript.

AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.

Institutional review board statement: This study was approved by the Institutional Review Board of Ain Shams University Hospital (Approval No. FMASU R124/2024).

Clinical trial registration statement: This prospective study was not registered because it was initially classified as a prospective observational study rather than an interventional clinical trial at the time of study initiation. The sequence of hemodialysis modality shifts in our study reflects current clinical practice trends. The study protocol, inclusion criteria, and outcomes were established prior to patient enrollment and remained unchanged throughout the study.

Informed consent statement: All legal guardians of all patients involved in the study provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available because individual privacy could be compromised. However, they are available from the corresponding author on reasonable request.

Corresponding author: Ragia M Said, Professor, Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Ain Shams University, 38 Abbassia Square, Next to Al-Nour Mosque, Cairo 1181, Egypt. ragia_marei@med.asu.edu.eg

Received: February 14, 2026
Revised: March 16, 2026
Accepted: May 15, 2026
Published online: September 9, 2026
Processing time: 167 Days and 20.6 Hours

Abstract

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.

Keywords: Soluble intercellular adhesion molecule-1; Hemodialysis; Online hemodiafiltration; Chronic kidney disease; Low-flux hemodialysis; High-flux hemodialysis

Core Tip: Children on chronic hemodialysis (HD) are exposed to persistent inflammation, which contributes to endothelial activation and cardiovascular risk. The type of dialysis modality may influence this inflammatory burden. This study evaluates the effect of low-flux HD, high-flux HD, and online hemodiafiltration (OL-HDF) on circulating intercellular adhesion molecule-1 (ICAM-1), a marker of endothelial activation, in pediatric patients. Low-flux HD increased post-session soluble ICAM-1 levels, suggesting dialysis-related endothelial injury, whereas high-flux HD and OL-HDF significantly reduced its levels, with OL-HDF normalizing ICAM-1 to values comparable to healthy controls. These findings suggest that selecting more biocompatible and high-efficiency dialysis modalities may help mitigate dialysis-related inflammation and potentially reduce long-term endothelial activation in pediatric HD patients.