Initiation of hemodialysis treatment leads to improvement of T-cell activation in patients with end-stage renal disease

Patients with chronic renal failure show an immunodeficiency characterized by frequent infectious complications and a low response to vaccinations. Th is is paralleled in Vitro by a low T-cell proliferation on mitogenic stimul i because of an impaired costimulation by accessory cells. Furthermore, alt erations of the cytokine profile are correlated with impaired immune functi on. The immune system is influenced by both uremia and renal replacement th erapy. To evaluate the influence of hemodialysis on immune parameters, we s tudied patients before and after the initiation of chronic hemodialysis the rapy. Fourteen patients with end-stage renal failure were tested before dia lysis initiation and during the first 6 weeks of hemodialysis treatment. We determined the in vitro T-cell proliferation, as well as plasma levels of interleukin-g (IL-6) and the release of IL-6 and IL-10 into culture superna tant poststimulation with lipopolysaccharide. After 6 weeks of intermittent hemodialysis, in vitro T-cell proliferation on stimulation improved signif icantly (stimulation index, 21.6 +/- 18.5 versus 58.1 +/- 45.5; P < 0.01). This improvement occurred regardless of whether synthetic dialyzers or cell ulosic membranes were used for the initiation of dialysis. Plasma IL-6 leve ls, as well as IL-6 and IL-10 secretion, did not change during the study pe riod. in patients with end-stage renal disease, the initiation of hemodialy sis led to a significant improvement of in Vitro T cell proliferation. This effect may have a role for an improvement of immune function in vivo. The expected normalization of IL 6 and IL-10 production may be masked by cytoki ne induction through hemodialysis membranes. (C) 2000 by the National Kidne y Foundation Inc.