Influence of hemodialysis on circulating CD4lowCD25high regulatory T cells in end-stage renal disease patients

Abstract

ObjectiveImmunodeficiency of end-stage renal disease (ESRD) is caused by several factors including uremic toxins and biocompatibility reactions due to the repeated hemodialysis (HD) procedure. It has also been suggested that poor T cell responses could be associated with the increased number of regulatory T cells (Tregs) which are necessary to limit the function of activated T cells. The aim of the study was to determine the proportion of CD4+CD25+ cells (activated T cells) to CD4lowCD25high cells (Tregs) within the CD4+ population in ESRD patients.Patients and methodsTwo groups of ESRD patients, predialysis patients treated conservatively and patients undergoing hemodialysis (HD), as well as healthy controls were included in the study. Percentages of activated and regulatory T cells were determined ex vivo with flow cytometry based on the expression of CD4 and CD25 antigens.Results and conclusionsHD patients showed an increased percentage of CD4+CD25+ cells when compared with healthy controls, while there was no difference in the percentage of CD4lowCD25high cells between the patient groups. In our opinion, the repeated hemodialysis procedure significantly disturbs the balance between activated T cells and regulatory T cells in ESRD patients. Lack of Treg mobilization and chronic stimulation of T cells may contribute to the immune deficiency observed in these patients.

Flow cytometric evaluation of T and B lymphocyte percentage in chronic kidney disease

“…Comparison of haemoglobin and albumin concentrations vestigated and discussed with inconclusive results. The majority of studies showed that numbers of CD3 + , CD4 + , and CD8 + T lymphocytes and B lymphocytes were decreased in haemodialysis-treated patients [4][5][6]. In our study, CD3 + T lymphocytes and CD19 + B lymphocytes were numerically lower in patients on haemodialysis than in healthy donors.…”

The Influence of Hemodialysis on T Regulatory Cells: A Meta-Analysis and Systematic Review

“…4 ). The studies included in this additional analysis are Lisowska et al [13] , Kim et al [22] and Zhang et al [23] . This analysis aimed to understand if the difference measured between CKD G5D patients and HCs is due to uremic state or hemodialysis treatments.…”

“…Five studies that included comparable HC and CKD G5D patients and used similar criteria for determining the percentage of Treg cells in total CD4 T-cells were subjected to a meta-analysis [13,[21][22][23][24] . The complete list of articles included in the systematic review is described in table 1 .…”

“…Nearly half of CKD G5D patients suffer from chronic inflammation, which is caused by several factors including uremic toxins, issues of biocompatibility to dialysis membranes and other etiologies [13,14] . Paradoxically, in the setting of chronic immune cell activation, CKD G5D patients are at increased risk for several types of infections and respond poorly to vaccinations [15,16] .…”

“…A tabular summary of the relevant studies is provided ( table 1 ) [6,13,15,[19][20][21][22][23][24][25].…”