Dendritic Cell Dysfunction in Patients with End-stage Renal Disease

Abstract

End-stage renal disease (ESRD) with immune disorder involves complex interactions between the innate and adaptive immune responses. ESRD is associated with various alterations in immune function such as a reduction in polymorphonuclear leukocyte bactericidal activity, a suppression of lymphocyte proliferative response to stimuli, and a malfunction of cell-mediated immunity at the molecular level. ESRD also increases patients' propensity for infections and malignancies as well as causing a diminished response to vaccination. Several factors influence the immunodeficiency in patients with ESRD, including uremic toxins, malnutrition, chronic inflammation, and the therapeutic dialysis modality. The alteration of T-cell function in ESRD has been considered to be a major factor underlying the impaired adaptive cellular immunity in these patients. However, cumulative evidence has suggested that the immune defect in ESRD can be caused by an Ag-presenting dendritic cell (DC) dysfunction in addition to a T-cell defect. It has been reported that ESRD has a deleterious effect on DCs both in terms of their number and function, although the precise mechanism by which DC function becomes altered in these patients is unclear. In this review, we discuss the effects of ESRD on the number and function of DCs and propose a possible molecular mechanism for DC dysfunction. We also address therapeutic approaches to improve immune function by optimally activating DCs in patients with ESRD.

Immune mechanisms in the different phases of acute tubular necrosis

“…Reduced renal function causes alterations in immunity, observed both in persistent systemic sterile inflammation and in acquired immunosuppression [ 102 ]. Accordingly, patients suffering from CKD fail to generate an appropriate immune response to infections [ 103 ], a condition that can be largely explained by uremic toxin-induced immune suppression. Uremia triggers neutrophil apoptosis and oxidative burst in mononuclear phagocytes [ 104 ].…”

A new method to determine anastomosis angle configuration for arteriovenous fistula maturation

“…To achieve the goals of the study, the data of 48 ESRD patients were collected in 3 stages: (1) preoperative (age, gender, marital status, weight, height, smoking, diabetes mellitus (DM), hypertensive, hearth disease, drugs, CKD duration), (2) intraoperative (AVF hand (right/left), AVF site (radial/radial up), anastomosis type (end-to-side (ETS) /side-to-side (STS)), image processing and vessels characteristics measuring), and (3) postoperative (AVF status (failure/ maturation)). One of the AVF images is shown in Fig.…”

“…End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD) in which the kidneys no longer function well enough to meet the needs of daily life (1), and it has been estimated that almost 10% of the worldwide population is affected by CKD (2). Patients with ESRD need renal replacement therapies (RRTs) such as hemodialysis (HD), peritoneal dialysis (PD), or kidney transplantation (3).…”

“…HD requires an access for connecting the dialyzer machine to the patient’s vascular system, and this connection is provided by a vascular access (VA). There are 3 main types of VA: (1) arteriovenous fistula (AVF), (2) arteriovenous graft (AVG), and (3) central venous catheter (CVC). AVF has the least association with morbidity and mortality, thus, different countries strongly recommend AVF (5).…”

Immune Dysfunction in Uremia 2020

“…The terminal differentiation of monocyte-derived dendritic cells is compromised in advanced CKD and independent of HD treatment [53]. An antigen-presenting dendritic cell dysfunction, beside a T-cell defect, can cause a diminished response to vaccination in ESRD patients [54]. Dendritic cells are also present in the kidney and contribute to the progression of renal failure by binding to glomerular antigens [55].…”