Enhanced plasma and intracellular levels of main granulocyte components in diabetics on dialysis.

Intracellular and plasma levels of main granulocyte components (elastase, lactoferrin) were investigated in 25 diabetic and 27 nondiabetic patients undergoing regular hemodialysis treatment (RDT) as well as in 14 diabetic and 11 nondiabetic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Diabetic patients on dialysis released more intragranular enzymes from neutrophils than their nondiabetic counterparts. Intracellular concentrations of granulocyte elastase and lactoferrin were only slightly higher in uremic diabetics than in uremic nondiabetics. However, both diabetic and nondiabetic hemodialysis patients displayed significantly lower cellular elastase and lactoferrin levels than healthy subjects. In addition, the diabetic dialysis patients had more protein catabolic fragments in the plasma as determined by trichloroacetic acid solubility. These observations were cited to support the hypothesis that not only is the hemodialysis procedure itself (with exposure to membranes) catabolic, but the diabetics are in double jeopardy. Thus, neutrophil abnormalities in diabetics on dialysis might affect the plasmatic proteinase inhibitor system and contribute to enhanced plasma protein degradation as well as to enhanced susceptibility to infections.