Effects of end-stage renal disease and haemodialysis on dendritic cell subsets and basal and LPS-stimulated cytokine production

Abstract

ESRD results in significant DC depletion which is largely due to diminished plasmacytoid DC subset. Haemodialysis procedure intensifies DC depletion and impairs LPS-induced TNFalpha production.

Differentiation of Monocyte Derived Dendritic Cells in End Stage Renal Disease is Skewed Towards Accelerated Maturation

“…In this regard, we previously described an IL-12 overproduction of monocytes of ESRD patients, as a sign of chronic inflammation in ESRD [30]. The uremic milieu is generally thought to be immunosuppressive, not only in regard to maturation or function [28,29,31], but also in regard to decreased numbers of circulating DC during ESRD, further enhanced by the inflammatory stimulus during hemodialysis [32]. This led us and others [28,29] to the conclusion that the removal of uremic toxins by a more effective dialysis treatment might ameliorate DC function, thus providing a better outcome of patients undergoing hemodialysis.…”

Lymphocyte depletion and subset alteration correlate to renal function in chronic kidney disease patients

“…7,8 ESRD also results in dendritic cell (DC) depletion and dysfunction. [9][10][11] Given the critical role of DCs in regulation of innate and adaptive immunity, DC depletion can contribute to impaired defense against microbial infections and poor response to vaccination in this population. In addition to profoundly affecting the structure and function of innate immunity, CKD also impacts adaptive immunity mainly T and B lymphocyte.…”

Safety Issues in Iron Treatment in CKD

“…The main causes of CKD-associated immune deficiency include the following: (1) depletion of dendritic cells, which are the primary antigen-presenting cells 43 ; (2) reduced CD4 þ helper T-lymphocyte/CD8 þ suppressor T-lymphocyte ratio and depletion of naive and central memory T lymphocytes 44 ; (3) diffuse depletion of B lymphocytes, which contributes to impaired antibody production 45,46 ; (4) defective T-cell and natural killer cell proliferation 47,48 ; and (5) depressed phagocytic capacity and increased apoptosis of the neutrophilic PMN. 49,50 The immune system is affected adversely by both iron deficiency and iron overload.…”