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BioMed Research International
Volume 2018 (2018), Article ID 2670312, 6 pages
Clinical Study

Impaired Gut Epithelial Tight Junction Expression in Hemodialysis Patients Complicated with Intradialytic Hypotension

1Division of Renal Medicine, Tungs’ Metroharbor Hospital, Taichung, Taiwan
2Department of Rehabilitation, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
3Department of Pathology, Tungs’ Metroharbor Hospital, Taichung, Taiwan

Correspondence should be addressed to Paik-Seong Lim

Received 21 August 2017; Revised 30 October 2017; Accepted 22 November 2017; Published 16 January 2018

Academic Editor: Saima Riazuddin

Copyright © 2018 Tsai-Kun Wu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. There is accumulating evidence pointing to uremia-induced impairment of the intestinal epithelial barrier structure in advanced chronic kidney disease (CKD) and hemodialysis (HD) patients. In this study, the impact of intradialytic hypotension on intestinal barrier integrity is being explored. Methods. Immunohistochemical staining was used to detect the expression of 4 types of tight junction (TJ) proteins such as occludin, zonula occludens-1 (ZO-1), claudin-1, and claudin-4, in colonic samples of a group of patients receiving segmental colectomy. Five patients with nondialysis CKD (group 2), 5 HD patients with intradialytic hypotension (group 3), and 5 non-CKD subjects (group 1) were examined. Results. Both patients’ groups 2 and 3 demonstrated significantly reduced expression of occludin as compared to group 1 ( and , resp.). Except for claudin-4, expression of all markers of TJ proteins was significantly reduced in patients’ group 3 as compared to control (). In addition, decreased expressions of claudin-1 and ZO-1 were also more pronounced in group 3 when compared to group 2. Conclusions. This study extends the earlier finding by demonstrating that dialysis-related hypotension caused even marked depletion of the key protein constituents of the epithelial TJ.