Aspects of immune dysfunction in end-stage renal disease.
End-stage renal disease (ESRD) is associated with significantly increased morbidity and mortality resulting from cardiovascular disease (CVD) and infections, accounting for 50% and 20%, respectively, of the total mortality in ESRD patients. It is possible that these two complications are linked to alterations in the immune system in ESRD, as uremia is associated with a state of immune dysfunction characterized by immunodepression that contributes to the high prevalence of infections among these patients, as well as by immunoactivation resulting in inflammation that may contribute to CVD. This review describes disorders of the innate and adaptive immune systems in ESRD, underlining the specific role of ESRD-associated disturbances of Toll-like receptors. Finally, based on the emerging links between the alterations of immune system, CVD, and infections in ESRD patients, it emphasizes the potential role of the immune dysfunction in ESRD as an underlying cause for the high mortality in this patient population and the need for more studies in this area.
Kato
Sawako
S
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Chmielewski
Michal
M
Honda
Hirokazu
H
Pecoits-Filho
Roberto
R
Matsuo
Seiichi
S
Yuzawa
Yukio
Y
Tranaeus
Anders
A
Stenvinkel
Peter
P
Lindholm
Bengt
B
D050197:Atherosclerosis / Q000276:immunology; D002318:Cardiovascular Diseases / Q000276:immunology* / Q000401:mortality; D003141:Communicable Diseases / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007107:Immune System / Q000503:physiopathology*; D007113:Immunity, Innate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000276:immunology* / Q000401:mortality; D051192:Receptors, Pattern Recognition / Q000378:metabolism; D015398:Signal Transduction / Q000276:immunology; D051193:Toll-Like Receptors / Q000378:metabolism
D051192:Receptors, Pattern Recognition; D051193:Toll-Like Receptors