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Immune cell dysfunction and inflammation in end-stage renal disease
1Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Centre, Rotterdam, The Netherlands. m.g.h.betjes@erasmusmc.nl
Nature Reviews. Nephrology
|March 20, 2013
Summary
Uraemia in end-stage renal disease (ESRD) impairs immune function and accelerates aging, increasing cancer and infection risks. This immune aging persists even after kidney transplantation, suggesting stem cell alterations.
Area of Science:
- Nephrology
- Immunology
- Cardiovascular Medicine
Background:
- Uraemia in end-stage renal disease (ESRD) is linked to immune dysfunction, including increased cancer risk, infections, and poor vaccine response.
- Uraemia-associated inflammation likely contributes to the high atherosclerosis risk in ESRD patients.
- ESRD patients exhibit reduced lymphoid cells but normal/increased myeloid cells, with elevated inflammatory cytokines and reactive oxygen species.
Purpose of the Study:
- To investigate the impact of uraemia on immune system function and cellular composition in end-stage renal disease (ESRD) patients.
- To explore the concept of premature immunological aging in ESRD and its potential link to cardiovascular risk factors.
- To determine if immune system cellular composition normalizes after kidney transplantation.
Main Methods:
- Comparative analysis of immune cell populations (lymphoid vs. myeloid) and their functions in uraemic patients versus healthy controls.
- Assessment of inflammatory markers, cytokines, and reactive oxygen species in ESRD.
- Evaluation of immune cell composition and inflammatory status in ESRD patients pre- and post-kidney transplantation.
Main Results:
- ESRD patients show reduced lymphoid cell numbers/function but normal/increased myeloid cells with heightened inflammation.
- Increased proinflammatory T cells and monocytes in ESRD suggest premature immunological aging, acting as cardiovascular risk factors.
- Immune system cellular composition did not normalize post-transplantation, indicating persistent skewing towards myeloid-generating stem cells.
Conclusions:
- Uraemia induces premature immune system aging in ESRD patients, characterized by myeloid cell bias and inflammation.
- This immune aging is associated with increased cardiovascular risk and persists post-transplantation.
- Permanent alterations in hematopoietic stem cells may underlie the persistent immune aging observed in ESRD patients.
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