NDT Advance Access originally published online on May 10, 2005
Nephrology Dialysis Transplantation 2005 20(9):1868-1873; doi:10.1093/ndt/gfh897
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The effects of chronic kidney disease and renal replacement therapy on circulating dendritic cells
Erasmus University Medical Center, Internal Medicine, Division of Nephrology and Renal Transplantation, Rotterdam, The Netherlands
Correspondence and offprint requests to: D. A. Hesselink, Department of Internal Medicine, Division of Nephrology and Renal Transplantation, Room Ee 563 A, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands. Email: d.a.hesselink{at}erasmusmc.nl
Background. The mechanisms underlying the immunodeficiency of chronic kidney disease (CKD) are incompletely understood. Recently, we described decreased numbers of myeloid (m) and plasmacytoid (p) dendritic cells (DCs), considered the most important antigen-presenting cells, in peripheral blood of patients on chronic intermittent haemodialysis (CIHD). In this study, we analysed whether this reduction resulted from CKD or from renal replacement therapy (RRT).
Methods. Using flowcytometry, we quantified mDCs and pDCs in peripheral blood of patients maintained on CIHD (n = 37), continuous ambulatory peritoneal dialysis (CAPD; n = 29), and patients with CKD not receiving RRT (n = 37). Twenty-nine healthy volunteers served as controls.
Results. Patients with CKD (n = 103) had lower pDC and mDC counts compared with volunteers: 4.2 vs 8.3 and 10.0 vs 13.8x106 cells/l, respectively (P 
0.001). Within the CKD group, pDC counts did not differ between patients on CIHD, CAPD and those not receiving RRT (3.6 vs 5.0 vs 4.9x106 cells/l, respectively). In the latter group, pDC numbers correlated with the glomerular filtration rate (GFR; Spearman's r = 0.49; P<0.01). In contrast, mDC counts of patients on CIHD were lower compared with patients on CAPD (7.5 vs 10.1x106 cells/l; P = 0.039) and patients not receiving RRT (13.7x106 cells/l; P<0.001). Among non-dialyzing patients, no correlation existed between GFR and mDC numbers, which were comparable to those of volunteers, even when only non-dialyzing patients with a GFR below 15 ml/min were analysed.
Conclusions. Circulating DC counts are decreased in patients with CKD; for pDCs, this reduction is primarily related to the loss of GFR, whereas the dialysis treatment appears to affect mDC numbers.
Keywords: chronic haemodialysis; chronic kidney failure; chronic renal disease; continuous ambulatory peritoneal dialysis; immunodeficiency; renal replacement therapy
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