Basic Science and Dialysis: Disturbances of Acquired Immunity in Hemodialysis Patients

Abstract

Acquired immunity disturbances in hemodialysis (HD) patients are many and diverse. They are caused by uremia per se, the HD procedure, chronic renal failure complications, and therapeutic interventions for their treatment. Current data suggest that acquired immunity disturbances in HD patients concern mainly the T-lymphocyte and the antigen-presenting cell (APC). The T-lymphocyte-dependent immune response is deficient, predisposing to infections and inadequate response to vaccinations. In addition, APCs are preactivated, which seems to be responsible for the malnutrition-inflammation-atherosclerosis syndrome, and also affects T-lymphocyte function. At the molecular level it is assumed that the interaction between the APC and the T-lymphocyte is impaired. This disturbance is likely to concern the signal that results from the interaction between the major histocompatibility complex:peptide complex on APC surfaces and T-cell receptors on T-lymphocyte surfaces, or the signal that results from the interaction among the co-receptors of these two cells. The aim of the present review was to collect and classify the available clinical and experimental data in this area. Although many pieces are still missing from the puzzle, a better understanding of the responsible molecular mechanisms, will potentially lead to increased survival and a better quality of life in HD patients.

Aspects of Immune Dysfunction in End-stage Renal Disease

“…The increased rate of infections, together with an impaired response to vaccination and a common failure of tuberculin skin test to diagnose latent tuberculosis indicate that the adaptive immunity is weakened in the ESRD population (44). Studies performed in vitro show that T-cell proliferation is decreased in the uremic milieu (45,46).…”

“…It is now acknowledged that altered T lymphocyte function, found in ESRD, can be attributed to impaired function of APCs (44). Because T-cell activation by APCs is dependent to a great extent on TLRs, it will be described in more detail below.…”

CD4+/FOXP3+ Regulatory T Cells in End-Stage Kidney Disease: Molecular Pathways Trough Cell-Cycle Arrest and Apoptosis

“…The increased rate of infections, together with an impaired response to vaccination and a common failure of tuberculin skin test to diagnose latent tuberculosis indicate that the adaptive immunity is weakened in the ESKD population [3]. Studies performed in vitro show that T-cell proliferation is decreased in the uremic milieu [4,5].…”

Efficacy and safety of the H1N1 monovalent vaccine in renal-transplant recipients and dialysis patients

“…Acquired immunity disturbances in chronic kidney-disease (CKD) patients can be caused by uraemia, 13 as well as by the dialysis procedure, 14 chronic renal-failure complications and previous immunosuppressive treatments in RTRs. In CKD patients, these disturbances mainly involve T lymphocytes and antigen-presenting cells, 14 which lead to a lower ability to induce an immune response. In hemodialysis patients, uraemic toxins, blood transfusions, iron overload, dialysis membranes and biological incompatibility can adversely affect the immune response.…”