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NDT Advance Access published online on July 8, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp287
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Haemodialysis-induced transient CD16+ monocytopenia and cardiovascular outcome

Kyrill S. Rogacev, Maren Ziegelin, Christof Ulrich, Sarah Seiler, Matthias Girndt, Danilo Fliser and Gunnar H. Heine

Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany

Correspondence and offprint requests to: Gunnar H. Heine; E-mail: Gunnar.Heine{at}uks.eu



  Abstract

Background. Haemodialysis with bioincompatible membranes led to transient leukocyte activation and intra-dialytic leukopenia due to endothelial adherence. After the introduction of biocompatible membranes, only CD16+ (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 intra-dialytic 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.

Keywords: Biocompatibility; cardiovascular disease; epidemiologic; haemodialysis; immunologic

Received for publication: 12. 1.09
Accepted in revised form: 23. 5.09


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