title: Chronic kidney disease and premature ageing of the adaptive immune response.
abstract: Los of renal function is associated with uremia-associated immune deficiency, which contributes significantly to the mortality and morbidity of end-stage renal disease (ESRD) patients. In this review, the effect of ESRD on the adaptive cellular immune system is discussed. Progressive loss of renal function causes a preferential loss of number and function of lymphoid cells. More in depth analysis of these changes reveals a loss of thymic function, attrition of telomeres, and expanded memory T cell population, which is compatible with the concept of premature immunological ageing. Latency for cytomegalovirus is associated with more profound changes and the expansion of a unique pro-inflammatory, cytotoxic subset of CD4-positive CD28null T cells. Epigenetically, modifications in hematopoietic stem cells may underlie uremia-associated immunological ageing, which is not reversed by kidney transplantation. Possible therapeutic options to reverse or halt uremia-associated immunological ageing are discussed.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands, m.g.h.betjes@erasmusmc.nl.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.forename: Nicolle H R
authors.initials: NH
authors.lastname: Litjens
mesh_terms: D056704:Adaptive Immunity / Q000235:genetics / Q000276:immunology; D019588:Aging, Premature / Q000235:genetics / Q000276:immunology*; D016922:Cellular Senescence / Q000235:genetics / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000235:genetics / Q000276:immunology; D044127:Epigenesis, Genetic; D006801:Humans; D007111:Immunity, Cellular / Q000235:genetics / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000235:genetics / Q000276:immunology*; D008214:Lymphocytes / Q000276:immunology* / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000235:genetics / Q000276:immunology; D016615:Telomere / Q000378:metabolism; D014511:Uremia / Q000235:genetics / Q000276:immunology*