Influence of end stage renal disease onCD28expression and T-cell immunity

Background T-cell immunity is affected in end stage renal disease (ESRD). However, whether this happens at pre- or post-dialysis stage and what is the impact of different renal replacement methods, remains unclear. We investigated the alterations of T-cell subtypes in patients at pre-dialysis ESRD and their further changes during dialysis. Methods CD4+, CD8+, CD4 + CD28null and CD8 + CD28null T-cells were analysed in 40 ESRD patients at two different time points, (a) the day started on dialysis (ESRD-T0) and (b) 6 months later (ESRD-T6), while being on haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Twenty-five age matched healthy volunteers served as controls. Results CD4+ and CD8+ T-cells were significantly reduced in ESRD-T0 patients compared to controls, 604 (105-3551) vs 943 (584-1867)mu/L,P= .001, and 352 (103-1561) vs 422.4 (263-1453)mu/L,P= .05, respectively. However, proportions of CD4 + CD28null and CD8 + CD28null cells were significantly increased, 6.4 (0.3-30)% vs 2.7 (0.1-7.8)%,P= .04 and 58.2 (12.8-85.4)% vs 39 (7.8-57.1)%,P= .01, respectively. Proportion of CD4 + CD28null cells showed significant correlation with serum CRP (r= .4,P= .04) and albumin levels (r= -.5,P= .007) in ERSD patients. ESRD-T0 patients with cardiovascular disease (CVD) had increased CD4 + CD28null and CD8 + CD28null proportions, 8.6 (1-30)% vs 2.1 (0.1-19.8)%,P= .04 and 62.5 (12.8-85.4)% vs 45.5 (5.7-73.7)%,P= .02, respectively, compared to those without. Six months later, both CD4 + CD28null and CD8 + CD28null T-cells were increased in HD compared to CAPD patients, by +110.11 (-27.1 to 311.4)% vs -28.1 (-100 to 30)%,P= .003 and +55.23 (-29.06 to 197.93)% vs -8.34 (-54.99 to 66.72)%,P= .05, respectively. Conclusions CD4 + CD28null and CD8 + CD28null T-cells are increased at pre-dialysis ESRD, and correlate with chronic inflammatory markers and the presence of CVD. Dialysis methods seem to have different impact on these subpopulations.

Automated summary

In ESRD patients, CD4+ and CD8+ T-cell counts were significantly reduced, while CD4+ CD28null and CD8+ CD28null cells were significantly increased. The proportions of CD4+ CD28null cells were correlated with serum CRP and albumin levels.