Immune response of patients with renal failure after induction of hemodialysis

Suppression of immune responses in uremia and in hemodialysis is a well-known but poorly understood phenomenon. This study reports in vitro lymphocyte responses of 20 patients with renal failure due to glomerulonephritis, for 12 months following the induction of hemodialysis (HD). The patients were divided into two groups of 10 patients each based on the dialysis membrane used, a cellulose group and a PMMA group. Peripheral blood samples were taken immediately before and after the induction of HD and just before every HD. The T-cell response to phytohemagglutinin-P was evaluated by 3H-thymidine incorporation. After stimulation with pokeweed mitogen, antibody-producing cells were counted on a fluorescence-activated cell sorter (FACS IV). T-cell subsets were analyzed with the FACS IV by using monoclonal antibodies (Leu 2a and Leu 3a). Circulating immune complexes (CIC) quantified by the 3.5% polyethylene glycol (mol. wt; 6, 000) precipitation method. The following results were obtained; (1) The T-cell response was reduced as time elapsed; percent inhibition was 18.2% at 14 days, 24.5% at 28 days, 58.3% at 6 months and 66.6% at 12 months. When the two groups were compared, the reduced response was seen in the PMMA group earlier than in the cellulose group (14 days versus 28 days). (2) There were no apparent changes in B-cell function and the Leu 3a/Leu 2a ratio. (3) CIC levels were reduced one day after the induction of HD in the cellulose group, but not in the PMMA group. However, they increased to the pre-induction levels on and after the 7th day after the first HD. (4) There was no significant change in the complement (C3 and C4) level. These results strongly suggest that reduced T-cell function is not related to the ratio of the T-cell subsets but is due to functional abnormalities associated with HD.