Melatonin ingestion before intradialytic exercise improves immune responses in hemodialysis patients

Abstract

Purpose: The present study aimed to investigate the effects of melatonin (MEL) intake on systemic inflammation and immune responses during intradialytic exercise.

Methods: Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized-crossover study. Immunological responses were monitored in four HD sessions at different conditions: [Exercise (EX) + MEL], [EX + Placebo (PLA)], [Control (CON) + MEL] and [CON + PLA]. MEL (3 mg) or PLA was ingested 1 h before starting exercise or the equivalent time in CON condition. During all sessions, peripheral blood samples were collected to assess c-reactive protein, complete blood count, and immune cells phenotypes before HD (T0), immediately after exercise (T1) and 1 h after exercise (T2) or at corresponding times in the CON condition.

Results: HD therapy induced a significant decrease in natural killer (NK) (p = 0.001, d = 0.85; p < 0.001, d = 1.19, respectively) and CD8⁺ T-lymphocytes rates (p = 0.001, d = 0.57; p < 0.001, d = 0.75, respectively) at T1 and T2 compared to T0. MEL intake prevented the decrease in NK and CD8⁺ T-lymphocytes, increased the proportion of CD4⁺ T-lymphocytes at T1 and T2 compared to T0 (p = 0.002, d = 1.18; p = 0.001, d = 1.04, respectively) and decreased the proportion of CD14⁺⁺CD16⁺ Monocytes at T2 compared to T0 (p = 0.02, d = 1.57) in peripheral blood during HD therapy. Similar results were found in [EX + MEL] and [EX + PLA] conditions.

Conclusion: This pilot study provides the first evidence that MEL intake alone or associated with intradialytic exercise displays potential immunoregulatory and anti-inflammatory effects. The combination of MEL with intradialytic exercise may be an appropriate anti-inflammatory therapy for HD patients.

Keywords: Immune cells; Inflammation; Intradialytic exercise; Melatonin; Renal failure.