Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin

Campo, Susanna; Lacquaniti, Antonio; Trombetta, Domenico; Smeriglio, Antonella; Monardo, Paolo

doi:10.3390/jcm11133759

Cited by 44 publications

(36 citation statements)

References 108 publications

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“…Besides strong performance, hemocompatibility is another core element of a dialyzer. Contact of human blood to artificial surfaces of the dialyzer may activate the immune system, leading to complement activation, coagulation and inflammation, with negative clinical consequences for the patients [ 14 , 15 , 16 , 17 ]. Additionally, here, the membrane has the strongest effect on the hemocompatibility profile of the dialyzer, as it has the largest contact surface with the patients’ blood during dialysis.…”

Section: Introductionmentioning

confidence: 99%

Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance

Zawada

Lang

Ottillinger³

et al. 2022

Membranes

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The dialyzer is the core element in the hemodialysis treatment of patients with end-stage kidney disease (ESKD). During hemodialysis treatment, the dialyzer replaces the function of the kidney by removing small and middle-molecular weight uremic toxins, while retaining essential proteins. Meanwhile, a dialyzer should have the best possible hemocompatibility profile as the perpetuated contact of blood with artificial surfaces triggers complement activation, coagulation and immune cell activation, and even low-level activation repeated chronically over years may lead to undesired effects. During hemodialysis, the adsorption of plasma proteins to the dialyzer membrane leads to a formation of a secondary membrane, which can compromise both the uremic toxin removal and hemocompatibility of the dialyzer. Hydrophilic modifications of novel dialysis membranes have been shown to reduce protein adsorption, leading to better hemocompatibility profile and performance stability during dialysis treatments. This review article focuses on the importance of performance and hemocompatibility of dialysis membranes for the treatment of dialysis patients and summarizes recent studies on the impact of protein adsorption and hydrophilic modifications of membranes on these two core elements of a dialyzer.

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Section: Introductionmentioning

confidence: 99%

Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance

Zawada

Lang

Ottillinger³

et al. 2022

Membranes

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show abstract

“…Immune system disorders are one of the main problems in end-stage renal disease (ESRD) patients undergoing hemodialysis (1,2), and the extent and severity of these disorders progress with the duration of kidney disease and dialysis treatment (1). The weakening of the immune system in these patients makes them susceptible to various infections (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…Immune system disorders are one of the main problems of dialysis patients. End-stage renal disease (ESRD) patients undergoing hemodialysis have disorders in both the innate immune system and the adaptive or specific immune system (1,2). Concerning the innate immune response, defects in the function of neutrophils and the complement system have been reported in these patients (3,4).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Naturally Acquired Immunity to Meningococcus in Hemodialysis Patients in Jahrom, Iran, 2022

et al. 2022

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Background: Immune system disorders are one of the main problems in end-stage renal disease (ESRD) patients undergoing hemodialysis. The weakening of the immune system in these patients makes them susceptible to various infections. Objectives: This research was conducted for the first time to investigate the prevalence of naturally acquired immunity to Meningococcus and its association with the duration of dialysis, gender, and age in hemodialysis patients. Methods: This descriptive cross-sectional study was conducted on patients suffering from chronic kidney disease undergoing hemodialysis referring to Jahrom Hemodialysis Center in March-August 2022. The qualitative level of anti-meningococcal polysaccharide antibodies was determined in serum samples using ELISA assay with specialized and commercial kits to determine the immunity to Meningococcus. Stata version 14 was used to analyze the data with the chi-square test, univariate, and multivariable logistic regression. Results: The prevalence of naturally acquired immunity to Meningococcus was 18.68% in hemodialysis patients. Sex, age, duration of hemodialysis, and the number of weekly dialysis sessions were associated with the acquired immunity to Meningococcus. Conclusions: As hemodialysis patients are not vaccinated against meningococci in Iran, 18.68% of the hemodialysis patients had a history of meningococcal infection. Considering the susceptibility of these patients to this infectious disease and its preventability, it is recommended to vaccinate these patients against meningococcal infection.

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“…Whereas systemic inflammation contributes to atherosclerosis, cardiovascular disease, and anemia, immune deficiency leads to an impaired response to vaccination and an increased incidence and severity of microbial infections [ 7 ]. These two entities, not mutually exclusive, could represent two sides of the same coin [ 8 ]: uremic-associated inflammation is closely related to the activation of the innate immune system and the depletion and impaired activities of T and B lymphocytes [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Free Light Chains, High Mobility Group Box 1, and Mortality in Hemodialysis Patients

Lacquaniti

Campo

Falliti

et al. 2022

JCM

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Background: Uremic toxins are associated with immune dysfunction and inflammation. The inadequate removal by hemodialysis (HD) of serum free light chains (FLCs) determines their accumulation. This study evaluated FLCs in HD patients, analyzing their relations with other biomarkers, such as serum high mobility group box 1 (HMGB1). Methods: FLC and HMGB1 were evaluated in a cohort of 119 HD patients. κFLC and λFLC were summated to give a combined (c) FLC concentration. Patients were followed prospectively until the end of the observation period of four years, or until the endpoint: the patient’s death. Results: cFLC values in HD patients were 244.4 (197.9–273.5) mg/L. We detected a significant reduction in CD8+ cells and a decreased CD4+/CD8+ ratio. HMGB1 levels were 94.5 (55–302) pg/mL. After multivariate analysis, cFLCs correlated with β2-microglobulin and the CD4+/CD8+ ratio. Subjects with cFLC values above 263 mg/L and with sHMGB1 values < 80 pg/mL experienced a significantly faster evolution to the endpoint (mean follow-up time to progression of 27.5 and 28.5 months, respectively; p < 0.001). After an adjusted multivariate Cox analysis, cFLCs were associated with 11% increased risk of death, whereas low sHMGB1 increased this risk by 5%. Conclusions: cFLCs and HMGB1 reflect the inflammation and immune dysfunction in HD patients representing two strong and independent risk markers of mortality.

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Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin

Cited by 44 publications

References 108 publications

Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance

Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance

Prevalence of Naturally Acquired Immunity to Meningococcus in Hemodialysis Patients in Jahrom, Iran, 2022

Free Light Chains, High Mobility Group Box 1, and Mortality in Hemodialysis Patients

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