title: Haemodialysis-induced transient CD16+ monocytopenia and cardiovascular outcome.
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.
authors: Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany.
authors: Kyrill S
authors: KS
authors: Rogacev
authors: Maren
authors: M
authors: Ziegelin
authors: Christof
authors: C
authors: Ulrich
authors: Sarah
authors: S
authors: Seiler
authors: Matthias
authors: M
authors: Girndt
authors: Danilo
authors: D
authors: Fliser
authors: Gunnar H
authors: GH
authors: Heine
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D058851:GPI-Linked Proteins; D006801:Humans; D007970:Leukopenia / Q000209:etiology*; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000502:physiology*; D017452:Receptors, IgG / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality
chemical_list: C428200:FCGR3B protein, human; D058851:GPI-Linked Proteins; D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG