Haemodialysis-induced transient CD16+ monocytopenia and cardiovascular outcome

被引:24
作者
Rogacev, Kyrill S. [1 ]
Ziegelin, Maren [1 ]
Ulrich, Christof [1 ]
Seiler, Sarah [1 ]
Girndt, Matthias [1 ]
Fliser, Danilo [1 ]
Heine, Gunnar H. [1 ]
机构
[1] Saarland Univ Hosp, Dept Internal Med 4, Homburg, Germany
关键词
Biocompatibility; cardiovascular disease; epidemiologic; haemodialysis; immunologic; CORONARY-ARTERY-DISEASE; STAGE RENAL-DISEASE; DIALYSIS PATIENTS; MONOCYTES; CD14(+)CD16(+); SEQUESTRATION; ACTIVATION; EXPRESSION; RECEPTOR; THERAPY;
D O I
10.1093/ndt/gfp287
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Haemodialysis with bioincompatible membranes led to transient leukocyte activation and intradialytic leukopenia due to endothelial adherence. After the introduction of biocompatible membranes, only CD 161 (i.e. CD14(++)CD16(+) and CD14((+))CD16(+)) monocytes showed an impressive transient intra-dialytic decrease. Presently, it is unclear whether this CD16(+) monocyte drop is detrimental. We investigated whether a prominent intradialytic decrease of CD16(+) monocytes predicts future cardiovascular (CV) events. Methods. We measured leukocyte and monocyte subpopulations in 70 patients before and 10 min after haemodialysis initiation. Patients were stratified by their intra-dialytic CD14(++)CD16(+) monocyte drop (pre-defined major drop: decline of cell counts at 10 min to <50% of pre-dialytic values; pre-defined minor drop: decline to values >50% of pre-dialytic counts). Patients were followed up for 42 +/- 2 months; endpoints were CV events and death. Results. Patients with a minor CD14(++)CD16(+) monocyte drop had more CV events than patients with a major drop. In multivariate analysis, a minor CD14(++)CD16(+) monocyte drop was the strongest independent predictor of future CV events [hazard ratio 2.405 (95% CI 1.192-4.854)]. Conclusions. These data refute the assumption that a prominent intra-dialytic decrease of CD14(++)CD16(+) monocytes is detrimental. Instead, a minor cell drop could mirror CD14(++)CD16(+) monocyte dysfunction, with inadequate migratory reaction towards an immunologic stimulus posed by membrane and tubing contact.
引用
收藏
页码:3480 / 3486
页数:7
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