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Research Article Volume 14 Issue 1
Toll-like receptor 2 and 4 expression in diabetic nephropathy patients undergoing hemodialysis: implications for innate immune activation and dialysis duration
Heba E Salama, Feday M Abbas
Received: February 13, 2026 | Published: April 15, 2026
Citation: Salam HE, Abba FM. Toll-like receptor 2 and 4 expression in diabetic nephropathy patients undergoing hemodialysis: implications for innate immune activation and dialysis duration. Urol Nephrol Open Access. 2026;14(1):32-36. DOI: 10.15406/unoaj.2026.14.00369
Abstract
Background: Diabetic nephropathy (DN) is a major global cause of end-stage renal disease and is now recognized as an immuno-metabolic disorder driven by innate immune activation. Toll-like receptors (TLR2 and TLR4) mediate sterile inflammation, yet their expression in DN patients undergoing hemodialysis (HD) remains underexplored. Objectives: To evaluate TLR2 and TLR4 gene expression in hemodialysis patients with diabetic nephropathycompared with non-diabetic HD patients and healthy controls, and to analyze correlations with clinical and laboratory parameters. Methods: A cross-sectional study of 90 participants divided equally into three groups: non-diabetic HD patients, diabetic nephropathy HD patients, and healthy controls. Clinical evaluation, laboratory tests, cytokine measurement, and qPCR quantification of TLR2/TLR4 expression (2^−ΔΔCt) were performed. Statistical analyses included ANOV A, Kruskal–Wallis, χ² tests, and correlation assessment. Results: TLR2 and TLR4 expression levels were significantly higher in DN patients on HD compared with non diabetic HD patients and healthy controls (p < 0.001).Hemodialysis duration demonstrated strong positive correlations with TLR2 (r = 0.832, p = 0.001) and TLR4 (r = 0.712, p = 0.001). No significant associations with HbA1c, creatinine, urea, or age were observed. Conclusion: DN patients on HD exhibit markedly elevated innate immune activation, reflected by increased TLR2 and TLR4 expression. Dialysis duration is a major determinant of TLR upregulation. TLR markers may serve as biomarkers for inflammatory burden and potential therapeutic targets in diabetic ESRD.
Keywords: diabetic nephropathy, Toll-like receptors, TLR2, TLR4, hemodialysis, innate immunity, inflammation, ESRD
©2026 Salam, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.