Nephrol Dial Transplant (1999) 14: 2807-2810
© 1999 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Impaired cellular immune function in patients with end-stage renal failure
Medical Department IV, University of Homburg/Saar, Germany
Correspondence and offprint requests to: Prof. Dr H. Köhler,Medical Department IV, University of Homburg/Saar, Kirrberger Str., D-66421 Homburg/Saar, Germany.
Patients with chronic renal failure are at high-risk for infectious complications, similar to patients with other types of acquired immune defects or those on immunosuppressive therapy. Secondary immune failure in uraemia is multi-faceted and is influenced by uraemic intoxication per se, by altered renal metabolism of immunologically active proteins and by specific effects of renal replacement therapy. Large interindividual variability points to the importance of individual factors. A high incidence of infection is found in uraemic patients and infections remain the second most frequent cause of death.
One specific problem is hepatitis B. Vaccination against hepatitis B is routinely performed in dialysis patients. Although effective in only 60–70% of patients, it helped to eliminate the threat of hepatitis B from dialysis centres. The response to hepatitis B vaccine proved to be a valid clinical index for individual immune reactivity in dialysis patients.
Cellular dysfunction: a defect of the antigen-presenting cell
Low response rates after vaccination against hepatitis
T-cell response: amplitude reduction and functional deviation
Monocytes in uraemia: defect in co-stimulation and chronic inflammation
Renal replacement therapy: influences on immune function
Summary and perspective: a curable defect?
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