Haemodialysis-induced transient CD16+ monocytopenia and cardiovascular outcome.
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.
Rogacev
Kyrill S
KS
Department of Internal Medicine IV, Saarland University Hospital, Homburg/Saar, Germany.
Ziegelin
Maren
M
Ulrich
Christof
C
Seiler
Sarah
S
Girndt
Matthias
M
Fliser
Danilo
D
Heine
Gunnar H
GH
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
C428200:FCGR3B protein, human; D058851:GPI-Linked Proteins; D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG