Abstract
Introduction: Chronic kidney disease (CKD) poses a significant global health burden, with increasing prevalence and high morbidity and mortality rates, particularly in end-stage kidney disease (ESKD). While traditional risk factors contribute, the exact mechanisms remain elusive, with inflammation playing a pivotal role. Medium cutoff (MCO) membranes offer promise in improving dialysis outcomes by efficiently clearing uremic toxins without substantial albumin loss. We aimed to elucidate the impact of MCO and high-flux (HF) membranes on peripheral blood lymphocyte subpopulations in hemodialysis patients. Methods: Twenty-four ESKD patients underwent 36 sessions each with MCO and HF membranes. Immunophenotyping by flow cytometry was performed to analyze lymphocyte subsets. Results: NK cell percentages significantly increased with MCO, returning to baseline with HF. Th1 cells decreased post-HF, while Th2 and Tfh cells increased with MCO and persisted. Treg cells remained stable with MCO but decreased with HF. Conclusion: MCO dialysis induced an anti-inflammatory shift, evidenced by increased Th2 and Tfh cells and stable Treg cells. NK cells also responded favorably to MCO. These findings underscore MCO membranes’ potential to modulate immune responses and improve patient outcomes in ESKD.
Journal Section:
Hemodialysis – Research Article
References
1.
GBD 2019 Diseases and Injuries Collaborators
. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
. Lancet
. 2020
;396
(10258
):1204
–22
. 2.
Kovesdy
CP
. Epidemiology of chronic kidney disease: an update 2022
. Kidney Int Suppl
. 2022
;12
(1
):7
–11
. 3.
Kenan Ates
NS
, Kocyigit
I
. National Nephrology, dialysis and transplantation Registry Report of Turkey 2022
. Ankara
: Turk Nefroloji Dernegi Yayinlari
; 2023
.4.
Yeun
JY
, Levine
RA
, Mantadilok
V
, Kaysen
GA
. C-Reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients
. Am J Kidney Dis
. 2000
;35
(3
):469
–76
. 5.
Cobo
G
, Lindholm
B
, Stenvinkel
P
. Chronic inflammation in end-stage renal disease and dialysis
. Nephrol Dial Transplant
. 2018
;33
(Suppl l_3
):iii35
–40
. 6.
Ronco
C
, Marchionna
N
, Brendolan
A
, Neri
M
, Lorenzin
A
, Martínez Rueda
AJ
. Expanded haemodialysis: from operational mechanism to clinical results
. Nephrol Dial Transplant
. 2018
;33
(Suppl l_3
):iii41
–47
. 7.
Sevinc
M
, Hasbal
NB
, Yilmaz
V
, Basturk
T
, Ahbap
E
, Sakaci
T
, et al. Comparison of circulating levels of uremic toxins in hemodialysis patients treated with medium cut-off membranes and high-flux membranes: Theranova in Sisli Hamidiye etfal (THE SHE) randomized control study
. Blood Purif
. 2020
;49
(6
):733
–42
. 8.
Xiang
FF
, Zhu
JM
, Cao
XS
, Shen
B
, Zou
JZ
, Liu
ZH
, et al. Lymphocyte depletion and subset alteration correlate to renal function in chronic kidney disease patients
. Ren Fail
. 2016
;38
(1
):7
–14
. 9.
Betjes
MG
. Uremia-associated ageing of the thymus and adaptive immune responses
. Toxins
. 2020
;12
(4
):224
. 10.
Lisowska
KA
, Pindel
M
, Pietruczuk
K
, Kuzmiuk-Glembin
I
, Storoniak
H
, Debska-Slizien
A
, et al. The influence of a single hemodialysis procedure on human T lymphocytes
. Sci Rep
. 2019
;9
(1
):5041
. 11.
Donadei
C
, Angeletti
A
, Pizzuti
V
, Zappulo
F
, Conte
D
, Cappuccilli
M
, et al. Impact of single hemodialysis treatment on immune cell subpopulations
. J Clin Med
. 2023
;12
(9
):3107
. 12.
Yeter
HH
, Korucu
B
, Akcay
OF
, Derici
K
, Derici
U
, Arinsoy
T
. Effects of medium cut-off dialysis membranes on inflammation and oxidative stress in patients on maintenance hemodialysis
. Int Urol Nephrol
. 2020
;52
(9
):1779
–89
. 13.
Hung
YH
, Lai
TS
, Belmouaz
M
, Tu
YC
, Lai
CF
, Lin
SL
, et al. Effects of medium cut-off polyarylethersulfone and polyvinylpyrrolidone blend membrane dialyzers in hemodialysis patients: a systematic review and meta-analysis of randomized controlled trials
. Membranes
. 2022
;12
(5
):443
. 14.
Sahutoglu
T
, Erinc
O
, Avsar
FN
. The impact of medium cut-off dialyzers on malnutrition-inflammation scores in maintenance hemodialysis patients
. Blood Purif
. 2024
;53
(3
):219
–28
. 15.
Zickler
D
, Schindler
R
, Willy
K
, Martus
P
, Pawlak
M
, Storr
M
, et al. Medium cut-off (MCO) membranes reduce inflammation in chronic dialysis patients-A randomized controlled clinical trial
. PLoS One
. 2017
;12
(1
):e0169024
. 16.
Angeletti
A
, Zappulo
F
, Donadei
C
, Cappuccilli
M
, Di Certo
G
, Conte
D
, et al. Immunological effects of a single hemodialysis treatment
. Medicina
. 2020
;56
(2
):71
. 17.
Lisowska
KA
, Storoniak
H
, Dębska-Ślizień
A
. T cell subpopulations and cytokine levels in hemodialysis patients
. Hum Immunol
. 2022
;83
(2
):134
–43
. 18.
Caprara
C
, Virzì
GM
, Chieregato
K
, Marchionna
N
, Corradi
V
, Brendolan
A
, et al. Immunomodulation driven by Theranova filter during a single HD session
. J Clin Med
. 2024
;13
(7
):2147
. 19.
Mansouri
L
, Nopp
A
, Jacobson
SH
, Hylander
B
, Lundahl
J
. Hemodialysis patients display a declined proportion of Th2 and regulatory T cells in parallel with a high interferon-γ profile
. Nephron
. 2017
;136
(3
):254
–60
. 20.
Sampani
E
, Vagiotas
L
, Daikidou
DV
, Nikolaidou
V
, Xochelli
A
, Kasimatis
E
, et al. End stage renal disease has an early and continuous detrimental effect on regulatory T cells
. Nephrology
. 2022
;27
(3
):281
–7
. 21.
Lorenz
G
, Shen
Y
, Hausinger
RI
, Scheid
C
, Eckermann
M
, Hornung
S
, et al. A randomized prospective cross over study on the effects of medium cut-off membranes on T cellular and serologic immune phenotypes in hemodialysis
. Sci Rep
. 2022
;12
(1
):16419
. 22.
Crotty
S
. T follicular helper cell biology: a decade of discovery and diseases
. Immunity
. 2019
;50
(5
):1132
–48
. 23.
Wang
L
, Rondaan
C
, de Joode
AAE
, Raveling-Eelsing
E
, Bos
NA
, Westra
J
. Changes in T and B cell subsets in end stage renal disease patients before and after kidney transplantation
. Immun Ageing
. 2021
;18
(1
):43
. 24.
Cappuccilli
M
, Bergamini
C
, Giacomelli
FA
, Cianciolo
G
, Donati
G
, Conte
D
, et al. Vitamin B supplementation and nutritional intake of methyl donors in patients with chronic kidney disease: a critical review of the impact on epigenetic machinery
. Nutrients
. 2020
;12
(5
):1234
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