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NDT Advance Access published online on September 9, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi095
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received September 28, 2004
Accepted July 21, 2005

Original Articles

Effects of uraemia and dialysis modality on polymorphonuclear cell apoptosis and function

Camila Sardenberg 1*, Paulo Suassuna 1, Maria Claudia Cruz Andreoli 1, Renato Watanabe 1, Maria Aparecida Dalboni 1, Sílvia Regina Manfredi 1, Oscar Pavão dos Santos 1, Esper Georges Kallas 2, Sérgio Antônio Draibe 1, and Miguel Cendoroglo 1

1 Division of Nephrology, Department of Medicine, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
2 Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil

* To whom correspondence should be addressed.
Camila Sardenberg, E-mail: camilasarden{at}einstein.br



  Abstract

Background. Previous studies have reported that incubation of polymorphonuclear cells (PMN) in uraemic plasma or with different haemodialysis membranes and peritoneal dialysis solutions increases apoptosis in this cell type. In addition, PMN harvested from uraemic patients show a reduced ability to generate superoxide in response to stimuli as well as impaired phagocytosis, chemotaxis and degranulation. The aim of the current study was to investigate the effect of uraemia and dialysis modality on apoptosis and function in freshly harvested non-incubated PMN.

Methods. Polymorphonuclear cells were harvested from 14 chronic haemodialysis (HD) patients, from 14 continuous peritoneal dialysis patients (CAPD), 28 chronic kidney disease (CKD), pre-dialysis patients and from 14 healthy subjects (Controls). In these in vivo experiments, PMN apoptosis was studied by means of flow cytometric analysis of annexin V binding to freshly isolated cells. Polymorphonuclear cell phagocytosis and production of reactive oxygen species by unstimulated or stimulated (S. aureus, fMLP, PMA) cells were also studied by flow cytometry using whole blood.

Results. We observed increased PMN apoptosis in CKD patients. CAPD and HD patients displayed PMN apoptosis rates similar to controls. In the HD group, PMN exhibited decreased phagocytosis rates. In contrast, phagocytosis rates in PMN from CAPD were not significantly different from controls. In the CKD and HD groups, apoptosis was inversely correlated with respiratory burst activity and phagocytosis.

Conclusion. Our results suggest that both uraemia and treatment modality may interfere with PMN apoptosis and function. Dialysis appears to normalize the increased PMN apoptosis rates observed in CKD patients.

Keywords: apoptosis; dialysis; immune dysfunction; polymorphonuclear cells; uraemia.
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