The effect of carbon dioxide water immersing on inflammation biomarker in patients with chronic kidney disease undergoing hemodialysis

DOI: https://doi.org/10.33024/minh.v9i4.3474

Authors

  • Yammar Yammar Fakultas Ilmu Kesehatan, Universitas Puangrimaggalatung
  • Annisa Suwahru Program Studi Terapi Gigi, Fakultas Ilmu Kesehatan, Universitas Sulawesi Barat
  • Andi Rizky Arbaim Hasyar Program Studi Fisioterapi, Fakultas Kedokteran, Universitas Hasanuddin
  • Irfan Idris Program Studi Fisioterapi, Fakultas Kedokteran, Universitas Hasanuddin
  • Irawan Yusuf Program Studi Fisioterapi, Fakultas Kedokteran, Universitas Hasanuddin
  • Haerani Rasyid Divisi Nefrologi-Hipertensi, Program Studi Ilmu Penyakit Dalam, Universitas Hasanuddin
  • Barangkau Barangkau Program Studi Keperawatan, Fakultas Ilmu Kesehatan, Universitas Puangrimaggalatung

Carbon Dioxide Chronic Kidney Disease Hydrotherapy Inflammation Intercellular Adhesion Molecule-1 Vascular Adhesion Molecule-1

Abstract

Background: Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) often exhibit elevated levels of ICAM-1 and VCAM-1, key biomarkers of inflammation, and are prone to microcirculatory dysfunction. Recent evidence suggests that carbon dioxide (CO₂)-rich water immersion may enhance microcirculation, yet its impact on inflammatory biomarkers in CKD patients on HD remains unclear.

Purpose: To evaluate the effect of CO₂-rich water immersion on ICAM-1 and VCAM-1 levels in CKD patients receiving HD.

Method: This experimental study involved 22 CKD patients randomized into two groups: 14 received CO2-rich water immersion and 8 received freshwater immersion. CO2-rich water was generated using JESC CREABC-2000, with both immersions maintained at 37–38°C. Patients immersed both legs for 10 minutes, 2–3 times weekly for one month, prior to HD sessions. Blood samples were collected on day 1 and day 28. Data were analyzed using the Wilcoxon test, with statistical significance set at P < 0.05.

Results: After one month, ICAM-1 and VCAM-1 levels decreased in the CO2-rich water group (42.895±58.833 to 39.690±41.911 ng/mL, P=0.650; 140.520±177.43 to 96.170±30.17 ng/mL, P=0.917). Conversely, levels increased in the freshwater group (ICAM-1: 38.642±40.975 to 63.978±80.659 ng/mL, P=1.000; VCAM-1: 100.430±34.89 to 131.920±59.80 ng/mL, P=0.461).

Conclusion: CO2-rich water immersion tended to reduce ICAM-1 and VCAM-1 levels in CKD patients undergoing HD, although the changes were not statistically significant. These findings suggest potential anti-inflammatory effects warranting further investigation with larger cohorts.

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References

Čejková, S., Králová-Lesná, I., & Poledne, R. (2016). Monocyte adhesion to the endothelium is an initial stage of atherosclerosis development. Cor et Vasa, 58(4), e419–e425.

de Faria, A. P., Ritter, A. M. V., Sabbatini, A. R., Corrêa, N. B., Brunelli, V., Modolo, R., & Moreno, H. (2016). Deregulation of soluble adhesion molecules in resistant hypertension and its role in cardiovascular remodeling. Circulation Journal, 80(5), 1196-1201.

Dogliotti, G., Galliera, E., Iorio, E., Valserra, M., Solimene, U., & Corsi, M. M. (2011). Effect of immersion in CO2-enriched water on free radical release and total antioxidant status in peripheral arterial occlusive disease. International angiology, 30(1), 12.

Dörr, O., Liebetrau, C., Möllmann, H., Gaede, L., Troidl, C., Rixe, J., Hamm, C., & Nef, H. (2014). Soluble fms-like tyrosine kinase-1 and endothelial adhesion molecules (Intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1) as predictive markers for blood pressure reduction after renal sympathetic denervation. Hypertension, 63(5), 984–990.

Finzgar, M., Melik, Z., & Cankar, K. (2015). Effect of transcutaneous application of gaseous carbon dioxide on cutaneous microcirculation. Clinical hemorheology and microcirculation, 60(4), 423-435.

Gambo, J. L., Pretorius, M., Todd-Tzanetos, D. R., Luther, J. M., Yu, C., Alp Ikizler, T., & Brown, N. J. (2012). Comparative effects of angiotensin-converting enzyme inhibition and angiotensin-receptor blockade on inflammation during hemodialysis. Journal of the American Society of Nephrology, 23(2), 334–342.

Gimbrone, M. A., & Garcia-Cardena, G. (2016). Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis. Circulation Research, 118(4), 620–636.

Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O’Callaghan, C. A., Lasserson, D. S., & Hobbs, F. R. (2016). Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PloS one, 11(7), e0158765.

Indonesian Renal Registry. (2015). Program Indonesian Renal Regestry (IRR). In 8th Report of Indonesian Renal Registry. Retrieved from: https://www.scribd.com/document/343253923/Indonesian-Renal-Registry-2015

Izumi, Y., Yamaguchi, T., Yamazaki, T., Yamashita, N., Nakamura, Y., Shiota, M., & Iwao, H. (2015). Percutaneous carbon dioxide treatment using a gas mist generator enhances the collateral blood flow in the ischemic hindlimb. Journal of Atherosclerosis and Thrombosis, 22(1), 38-51.

Kilic, I. D., Findikoqlu, G., Alihanoqlu, Y. I., Yildiz, B. Z., Uslu, S., Rota, S., & Evrengul. (2015). Circulating adhesion molecules and arterial stiffness. Cardiovascular Journal of Africa, 26(1), 21–24.

Kunutsor, S. K., Bakker, S. J. L., & Dullaart, R. P. F. (2017). Soluble vascular cell adhesion molecules may be protective of future cardiovascular disease risk: Findings from the PREVEND prospective cohort study. Journal of Atherosclerosis and Thrombosis, 24(8), 804–818.

Lakshmi, B. S., Devi, N. H., Suchitra, M. M., Rao, P. V. L. N. S., & Kumar, V. S. (2018). Changes in the inflammatory and oxidative stress markers during a single hemodialysis session in patients with chronic kidney disease. Renal Failure, 40(1), 534–540.

Makino, N., Maeda, T., & Abe, N. (2015). Effects of Immersion in Artificial Carbon Dioxide on Endothelial Function Assessed with Flow-Mediated Dilation in Patients with Type 2 Diabetes. The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine, 78(3), 276–284.

Ministry of Health of the Republic of Indonesia. (2017). InfoDATIN Pusat Data dan Informasi Kementerian Kesehatan RI: Situasi Penyakit Ginjal Kronis. Retrieved from: https://www.academia.edu/59896003/Infodatin_ginjal

Mrowka, C., & Sieberth, H. G. (1995). Detection of circulating adhesion molecules ICAM-1, VCAM-1 and E-Selectin in Wegener’s granulomatosis, systemic lupus erythematosus and chronic renal failure. Clinical Nephrology, 43(5), 288–296.

Muller, W. A. (2014). How endothelial cells regulate transmigration of leukocytes in the inflammatory response. The American Journal of Pathology, 184(4), 886–896.

Nitta, K., Goto, S., Masakane, I., Hanafusa, N., Taniguchi, M., Hasegawa, T., & Nakamoto, H. (2020). Annual dialysis data report for 2018, JSDT Renal Data Registry: survey methods, facility data, incidence, prevalence, and mortality. Renal Replacement Therapy, 6(1), 41.

Ogoh, S., Nagaoka, R., Mizuno, T., Kimura, S., Shidahara, Y., Ishii, T., Kudoh, M., & Iwamoto, E. (2016). Acute Vascular Effects of Carbonated Warm Water Lower Leg Immersion in Healthy Young Adults. Physiological Reports, 4(23), 1–11.

Ogoh, S., Washio, T., Suzuki, K., Ikeda, K., Hori, T., Olesen, N. D., & Muraoka, Y. (2018). Effect of leg immersion in mild warm carbonated water on skin and muscle blood flow. Physiological Reports, 6(18), e13859.

Pagourelias, E. D., Zorou, P. G., Tsaligopoulos, M., Athyros, V. G., Karagiannis, A., & Efthimiadis, G. K. (2011). Carbon dioxide balneotherapy and cardiovascular disease. International journal of Biometeorology, 55(5), 657-663.

Papayianni, A., Alexopoulos, E., Giamalis, P., Gionanlis, L., Belechri, A. M., Koukoudis, P., & Memmos, D. (2002). Circulating levels of ICAM-1, VCAM-1, and MCP-1 are increased in haemodialysis patients: Association with inflammation, dyslipidaemia, and vascular events. Nephrology Dialysis Transplantation, 17(3), 435–441.

Rahawarin, A. A. R., Bahar, A., Akbar, M., Masadah, R., Wuysang, A. D., Bintang, A. K., & Halim, W. (2025). ICAM-1 and platelet counts as biomarkers for severity and outcomes in acute ischemic stroke: a cross-sectional study. Acta Biomed 96 (1) 1 - 7.

Saran, R., Robinson, B., Abbott, K. C., Bragg-Gresham, J., Chen, X., Gipson, D., & Shahinian, V. (2020). US renal data system 2019 annual data report: epidemiology of kidney disease in the United States. American Journal of Kidney Diseases, 75(1), A6-A7.

Steyers, C., & Miller, F. (2014). Endothelial Dysfunction in Chronic Inflammatory Diseases. International Journal of Molecular Sciences, 15(7), 11324–11349.

Wang, H., Naghavi, M., Allen, C., Barber, R. M., Bhutta, Z. A., Carter, A., & Bell, M. L. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet, 388(10053), 1459-1544.

Xu, Y. J., Elimban, V., & Dhalla, N. S. (2017). Carbon dioxide water-bath treatment augments peripheral blood flow through the development of angiogenesis. Canadian Journal of Physiology and Pharmacology, 95(8), 938–944.

Zatz, R., Seguro, A. C., & Malnic, G. (2011). Physiological bases of nephrology. In Physiological bases of nephrology (pp. 408-408).

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Published

2026-06-26

How to Cite

The effect of carbon dioxide water immersing on inflammation biomarker in patients with chronic kidney disease undergoing hemodialysis. (2026). MIN, 9(4), 529-536. https://doi.org/10.33024/minh.v9i4.3474