Uremia-Associated Immunological Aging and Severity of COVID-19 Infection

Abstract

One year after the start of the COVID-19 pandemic it has become clear that some groups of individuals are at particular high risk of a complicated course of infection resulting in high morbidity and mortality. Two specific risk factors are most prominent, old age and the presence of co-morbidity. Recent studies have shown that patients with compromised renal function, especially those treated with renal replacement therapy or having received a kidney transplant are at a much higher risk for severe COVID infection and increased mortality. This may be in part due to the increased prevalence of co-morbid conditions in these patients but specific alterations in their immune system, reflecting premature immunological aging, may be equally important. In this review the different aspects, in particular thymus function and memory T cell expansion, of uremia-associated immunological aging are reviewed with respect to COVID 19 infection. In essence, the decreased generation of naïve T cells may be instrumental in suboptimal anti-viral immune responses while the relatively uncontrolled expansion of effector T cells may facilitate the feared phase of the COVID-19 infection with excessive and live-threatening inflammation of the lung parenchyma.

Intensity of mycophenolate mofetil treatment is associated with an impaired immune response to SARS-CoV-2 vaccination in kidney transplant recipients

“…Thus, every increase in eGFR of 1 ml/min/1.73 m 2 increased the probability of developing IgGs by 3%. This observation is in line with a previous study 15 and might be explained by the fact that renal failure is associated with an impaired immune response especially with dysfunctional B cells 18,19 . In addition, other studies have indicated that calcineurin inhibitors, mTor inhibitors and age are additional factors influencing the immune response after SARS‐CoV‐2 vaccination in KTRs 4,15 .…”

“…This observation is in line with a previous study 15 and might be explained by the fact that renal failure is associated with an impaired immune response especially with dysfunctional B cells. 18 , 19 In addition, other studies have indicated that calcineurin inhibitors, mTor inhibitors and age are additional factors influencing the immune response after SARS‐CoV‐2 vaccination in KTRs. 4 , 15 These associations could not be found in our study as the patient number taking these immunosuppression drugs was too low.…”

Understanding the Effects of Age and T-Cell Differentiation on COVID-19 Severity: Implicating a Fas/FasL-mediated Feed-Forward Controller of T-Cell Differentiation

“…There is a dire need to explain the wide gamut of immune dysfunction in Covid-19 between mild and severe disease ( 35 ). Here, we incorporate a major correlation of Covid-1 severity; the proportion of CD8+ naïve T cells ( 12 , 23 , 36 ). As described by Moderbacher, et al, a higher proportion of these cells is protective in Covid-19.…”

Langfristige körperliche und psychische Folgen chronischer Nierenerkrankungen

“…Die COVID-19-Pandemie hat nachdrücklich verdeutlicht, wie vulnerabel die Gruppe der Patient:innen mit chronischen Nierenerkrankungen ist. Auch wenn es noch Jahre dauern wird, alle Aspekte der COVID-19-Erkrankung zu untersuchen und zu verstehen, die Einfluss auf den Verlauf von Nierenerkrankungen, die Dialyse und die Nierentransplantation haben, ist bereits jetzt klar, dass Patient:innen mit einer chronischen Nierenerkrankung nach einer SARS-CoV-2-Infektion eine schlechtere Prognose haben [ 70 , 71 ]. Und umgekehrt haben Patient:innen mit einem schweren Verlauf der COVID-19-Erkrankung ein erhöhtes Risiko, ein akutes Nierenversagen und im weiteren Verlauf eine chronische Niereninsuffizienz zu entwickeln [ 72 – 75 ].…”