Immunologic function and survival in hemodialysis patients
Immunologic function and survival in hemodialysis patients. Although the medical determinants of mortality in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) are well appreciated, the contribution of immunologic parameters to survival in such patients is unclear, especial...
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| Veröffentlicht in: | Kidney international 1998-07, Vol.54 (1), p.236-244 |
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| creator | Kimmel, Paul L. Phillips, Terry M. Simmens, Samuel J. Peterson, Rolf A. Weihs, Karen L. Alleyne, Sylvan Cruz, Illuminado Yanovski, Jack A. Veis, Judith H. |
| description | Immunologic function and survival in hemodialysis patients.
Although the medical determinants of mortality in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) are well appreciated, the contribution of immunologic parameters to survival in such patients is unclear, especially when variations in age, medical comorbidity and nutrition are controlled. In addition, although dysregulation of cytokine metabolisn has been appreciated in patients with ESRD, the association of these parameters with outcomes has not been established. Recently, the type of dialyzer used in patients’ treatment has been associated with survival, but the mechanisms underlying these findings, including their immune effects, have not been established. We conducted a prospective, cross-sectional, observational multicenter study of urban HD patients to determine the contribution of immunological factors to patient survival. We hypothesized increased proinflammatory cytokines would be associated with increased mortality, and that improved immune function would be associated with survival.
Patients were assessed using demographic and anthropometric indices, Kt/V, protein catabolic rate (PCR) and immunologic variables including circulating cytokine [interleukin (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-12, IL-13 and tumor necrosis factor (TNF)-α] levels, total hemolytic complement activity (CH50), and T cell number and function. A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. A Cox proportional hazards model, controlling for patients’ age, severity index, level of serum albumin concentration, dialyzer type and dialysis site was used to assess relative survival risk.
Two hundred and thirty patients entered the study. The mean (±sd) age of the population was 54.4 ± 14.2years, mean serum albumin concentration was 3.86 ± 0.47g/dl, mean PCR was 1.1 ± 0.28g/kg/day, and mean Kt/V 1.2 ± 0.3. Patients’ serum albumin concentration was correlated with levels of Kt/V and PCR, and their circulating IL-13 and TNF-α levels, but negatively with their circulating IL-2 levels, T-cell number and T-cell antigen recall function. T-cell antigen recall function correlated negatively with PCR, but not Kt/V. There was no correlation of any other immune parameter and medical or demographic factor. Immune parameters, however, were all highly intercorrelated. Mean level of circulating cytokines in HD patients were in all cases greater than thos |
| doi_str_mv | 10.1046/j.1523-1755.1998.00981.x |
| format | Article |
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Although the medical determinants of mortality in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) are well appreciated, the contribution of immunologic parameters to survival in such patients is unclear, especially when variations in age, medical comorbidity and nutrition are controlled. In addition, although dysregulation of cytokine metabolisn has been appreciated in patients with ESRD, the association of these parameters with outcomes has not been established. Recently, the type of dialyzer used in patients’ treatment has been associated with survival, but the mechanisms underlying these findings, including their immune effects, have not been established. We conducted a prospective, cross-sectional, observational multicenter study of urban HD patients to determine the contribution of immunological factors to patient survival. We hypothesized increased proinflammatory cytokines would be associated with increased mortality, and that improved immune function would be associated with survival.
Patients were assessed using demographic and anthropometric indices, Kt/V, protein catabolic rate (PCR) and immunologic variables including circulating cytokine [interleukin (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-12, IL-13 and tumor necrosis factor (TNF)-α] levels, total hemolytic complement activity (CH50), and T cell number and function. A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. A Cox proportional hazards model, controlling for patients’ age, severity index, level of serum albumin concentration, dialyzer type and dialysis site was used to assess relative survival risk.
Two hundred and thirty patients entered the study. The mean (±sd) age of the population was 54.4 ± 14.2years, mean serum albumin concentration was 3.86 ± 0.47g/dl, mean PCR was 1.1 ± 0.28g/kg/day, and mean Kt/V 1.2 ± 0.3. Patients’ serum albumin concentration was correlated with levels of Kt/V and PCR, and their circulating IL-13 and TNF-α levels, but negatively with their circulating IL-2 levels, T-cell number and T-cell antigen recall function. T-cell antigen recall function correlated negatively with PCR, but not Kt/V. There was no correlation of any other immune parameter and medical or demographic factor. Immune parameters, however, were all highly intercorrelated. Mean level of circulating cytokines in HD patients were in all cases greater than those of a normal control group. There were few differences in medical risk factors or immune parameters between patients treated with different types of dialyzers. After an almost three-year mean follow-up period, increased IL-1, TNF-α, IL-6, and IL-13 levels were significantly associated with increased relative mortality risk, while higher levels of IL-2, IL-4, IL-5, IL-12, T-cell number and function, and CH50 were associated with improved survival. The difference in survival between patients treated with unmodified cellulose dialyzers and modified or synthetic dialyzers approached the level of statistical significance, but there were no differences in levels of circulating cytokines between these two groups.
Higher levels of circulating proinflammatory cytokines are associated with mortality, while immune parameters reflecting improved T-cell function are associated with survival in ESRD patients treated with HD, independent of other medical risk factors. These factors may serve as markers for outcome. The mechanism underlying the relationship of immune function and survival, and the effect of interventions to normalize immune function in HD patients should be studied.</description><identifier>ISSN: 0085-2538</identifier><identifier>EISSN: 1523-1755</identifier><identifier>DOI: 10.1046/j.1523-1755.1998.00981.x</identifier><identifier>PMID: 9648084</identifier><identifier>CODEN: KDYIA5</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Black People ; chronic kidney failure ; cytokine ; Cytokines - blood ; Diabetic Nephropathies - immunology ; Diabetic Nephropathies - mortality ; Diabetic Nephropathies - therapy ; dialyzer ; Emergency and intensive care: renal failure. Dialysis management ; Female ; hemodialysis ; Humans ; Immune System - physiology ; Intensive care medicine ; interleukin ; Kidney Failure, Chronic - immunology ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - therapy ; Male ; Medical sciences ; Middle Aged ; Nutritional Physiological Phenomena ; Renal Dialysis - instrumentation ; Risk Factors ; Serum Albumin ; survival ; Survival Analysis ; T-cell ; tumor necrosis factor-α ; White People</subject><ispartof>Kidney international, 1998-07, Vol.54 (1), p.236-244</ispartof><rights>1998 International Society of Nephrology</rights><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c591t-6b81a0ce208f6162225bcfd5591f1e926a3e771069a7cd95b94f7af41d40b3f63</citedby><cites>FETCH-LOGICAL-c591t-6b81a0ce208f6162225bcfd5591f1e926a3e771069a7cd95b94f7af41d40b3f63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2314118$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9648084$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kimmel, Paul L.</creatorcontrib><creatorcontrib>Phillips, Terry M.</creatorcontrib><creatorcontrib>Simmens, Samuel J.</creatorcontrib><creatorcontrib>Peterson, Rolf A.</creatorcontrib><creatorcontrib>Weihs, Karen L.</creatorcontrib><creatorcontrib>Alleyne, Sylvan</creatorcontrib><creatorcontrib>Cruz, Illuminado</creatorcontrib><creatorcontrib>Yanovski, Jack A.</creatorcontrib><creatorcontrib>Veis, Judith H.</creatorcontrib><title>Immunologic function and survival in hemodialysis patients</title><title>Kidney international</title><addtitle>Kidney Int</addtitle><description>Immunologic function and survival in hemodialysis patients.
Although the medical determinants of mortality in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) are well appreciated, the contribution of immunologic parameters to survival in such patients is unclear, especially when variations in age, medical comorbidity and nutrition are controlled. In addition, although dysregulation of cytokine metabolisn has been appreciated in patients with ESRD, the association of these parameters with outcomes has not been established. Recently, the type of dialyzer used in patients’ treatment has been associated with survival, but the mechanisms underlying these findings, including their immune effects, have not been established. We conducted a prospective, cross-sectional, observational multicenter study of urban HD patients to determine the contribution of immunological factors to patient survival. We hypothesized increased proinflammatory cytokines would be associated with increased mortality, and that improved immune function would be associated with survival.
Patients were assessed using demographic and anthropometric indices, Kt/V, protein catabolic rate (PCR) and immunologic variables including circulating cytokine [interleukin (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-12, IL-13 and tumor necrosis factor (TNF)-α] levels, total hemolytic complement activity (CH50), and T cell number and function. A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. A Cox proportional hazards model, controlling for patients’ age, severity index, level of serum albumin concentration, dialyzer type and dialysis site was used to assess relative survival risk.
Two hundred and thirty patients entered the study. The mean (±sd) age of the population was 54.4 ± 14.2years, mean serum albumin concentration was 3.86 ± 0.47g/dl, mean PCR was 1.1 ± 0.28g/kg/day, and mean Kt/V 1.2 ± 0.3. Patients’ serum albumin concentration was correlated with levels of Kt/V and PCR, and their circulating IL-13 and TNF-α levels, but negatively with their circulating IL-2 levels, T-cell number and T-cell antigen recall function. T-cell antigen recall function correlated negatively with PCR, but not Kt/V. There was no correlation of any other immune parameter and medical or demographic factor. Immune parameters, however, were all highly intercorrelated. Mean level of circulating cytokines in HD patients were in all cases greater than those of a normal control group. There were few differences in medical risk factors or immune parameters between patients treated with different types of dialyzers. After an almost three-year mean follow-up period, increased IL-1, TNF-α, IL-6, and IL-13 levels were significantly associated with increased relative mortality risk, while higher levels of IL-2, IL-4, IL-5, IL-12, T-cell number and function, and CH50 were associated with improved survival. The difference in survival between patients treated with unmodified cellulose dialyzers and modified or synthetic dialyzers approached the level of statistical significance, but there were no differences in levels of circulating cytokines between these two groups.
Higher levels of circulating proinflammatory cytokines are associated with mortality, while immune parameters reflecting improved T-cell function are associated with survival in ESRD patients treated with HD, independent of other medical risk factors. These factors may serve as markers for outcome. The mechanism underlying the relationship of immune function and survival, and the effect of interventions to normalize immune function in HD patients should be studied.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Black People</subject><subject>chronic kidney failure</subject><subject>cytokine</subject><subject>Cytokines - blood</subject><subject>Diabetic Nephropathies - immunology</subject><subject>Diabetic Nephropathies - mortality</subject><subject>Diabetic Nephropathies - therapy</subject><subject>dialyzer</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>hemodialysis</subject><subject>Humans</subject><subject>Immune System - physiology</subject><subject>Intensive care medicine</subject><subject>interleukin</subject><subject>Kidney Failure, Chronic - immunology</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nutritional Physiological Phenomena</subject><subject>Renal Dialysis - instrumentation</subject><subject>Risk Factors</subject><subject>Serum Albumin</subject><subject>survival</subject><subject>Survival Analysis</subject><subject>T-cell</subject><subject>tumor necrosis factor-α</subject><subject>White People</subject><issn>0085-2538</issn><issn>1523-1755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EKkvhJyDlgLgleBJ_ckCiFR-VKnGBs-U4dutVYi92smr_Pd5uFMGJk2U9M--MnkGoAtwAJuzDvgHadjVwShuQUjQYSwHNwzO028BztMNY0LqlnXiJXuW8x-UvO3yBLiQjAguyQx9vpmkJcYx33lRuCWb2MVQ6DFVe0tEf9Vj5UN3bKQ5ej4_Z5-qgZ2_DnF-jF06P2b5Z30v06-uXn9ff69sf326uP9_WhkqYa9YL0NjYFgvHgLVtS3vjBlqgAytbpjvLOWAmNTeDpL0kjmtHYCC47xzrLtGnc-5h6Sc7mDI76VEdkp90elRRe_UvCf5e3cWjYkCYBFEC3q8BKf5ebJ7V5LOx46iDjUtWXEpOgXelUJwLTYo5J-u2IYDVybvaq5NeddKrTt7Vk3f1UFrf_r3k1riKLvzdynU2enRJB-PzVtZ2QOBp1TUm6HlJduOESNpRXvjVmdsi_OhtUtmUYxg7-GTNrIbo_7_rHz0FrHc</recordid><startdate>19980701</startdate><enddate>19980701</enddate><creator>Kimmel, Paul L.</creator><creator>Phillips, Terry M.</creator><creator>Simmens, Samuel J.</creator><creator>Peterson, Rolf A.</creator><creator>Weihs, Karen L.</creator><creator>Alleyne, Sylvan</creator><creator>Cruz, Illuminado</creator><creator>Yanovski, Jack A.</creator><creator>Veis, Judith H.</creator><general>Elsevier Inc</general><general>Nature Publishing</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19980701</creationdate><title>Immunologic function and survival in hemodialysis patients</title><author>Kimmel, Paul L. ; Phillips, Terry M. ; Simmens, Samuel J. ; Peterson, Rolf A. ; Weihs, Karen L. ; Alleyne, Sylvan ; Cruz, Illuminado ; Yanovski, Jack A. ; Veis, Judith H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c591t-6b81a0ce208f6162225bcfd5591f1e926a3e771069a7cd95b94f7af41d40b3f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Black People</topic><topic>chronic kidney failure</topic><topic>cytokine</topic><topic>Cytokines - blood</topic><topic>Diabetic Nephropathies - immunology</topic><topic>Diabetic Nephropathies - mortality</topic><topic>Diabetic Nephropathies - therapy</topic><topic>dialyzer</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>hemodialysis</topic><topic>Humans</topic><topic>Immune System - physiology</topic><topic>Intensive care medicine</topic><topic>interleukin</topic><topic>Kidney Failure, Chronic - immunology</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nutritional Physiological Phenomena</topic><topic>Renal Dialysis - instrumentation</topic><topic>Risk Factors</topic><topic>Serum Albumin</topic><topic>survival</topic><topic>Survival Analysis</topic><topic>T-cell</topic><topic>tumor necrosis factor-α</topic><topic>White People</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kimmel, Paul L.</creatorcontrib><creatorcontrib>Phillips, Terry M.</creatorcontrib><creatorcontrib>Simmens, Samuel J.</creatorcontrib><creatorcontrib>Peterson, Rolf A.</creatorcontrib><creatorcontrib>Weihs, Karen L.</creatorcontrib><creatorcontrib>Alleyne, Sylvan</creatorcontrib><creatorcontrib>Cruz, Illuminado</creatorcontrib><creatorcontrib>Yanovski, Jack A.</creatorcontrib><creatorcontrib>Veis, Judith H.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Kidney international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kimmel, Paul L.</au><au>Phillips, Terry M.</au><au>Simmens, Samuel J.</au><au>Peterson, Rolf A.</au><au>Weihs, Karen L.</au><au>Alleyne, Sylvan</au><au>Cruz, Illuminado</au><au>Yanovski, Jack A.</au><au>Veis, Judith H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Immunologic function and survival in hemodialysis patients</atitle><jtitle>Kidney international</jtitle><addtitle>Kidney Int</addtitle><date>1998-07-01</date><risdate>1998</risdate><volume>54</volume><issue>1</issue><spage>236</spage><epage>244</epage><pages>236-244</pages><issn>0085-2538</issn><eissn>1523-1755</eissn><coden>KDYIA5</coden><abstract>Immunologic function and survival in hemodialysis patients.
Although the medical determinants of mortality in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) are well appreciated, the contribution of immunologic parameters to survival in such patients is unclear, especially when variations in age, medical comorbidity and nutrition are controlled. In addition, although dysregulation of cytokine metabolisn has been appreciated in patients with ESRD, the association of these parameters with outcomes has not been established. Recently, the type of dialyzer used in patients’ treatment has been associated with survival, but the mechanisms underlying these findings, including their immune effects, have not been established. We conducted a prospective, cross-sectional, observational multicenter study of urban HD patients to determine the contribution of immunological factors to patient survival. We hypothesized increased proinflammatory cytokines would be associated with increased mortality, and that improved immune function would be associated with survival.
Patients were assessed using demographic and anthropometric indices, Kt/V, protein catabolic rate (PCR) and immunologic variables including circulating cytokine [interleukin (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-12, IL-13 and tumor necrosis factor (TNF)-α] levels, total hemolytic complement activity (CH50), and T cell number and function. A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. A Cox proportional hazards model, controlling for patients’ age, severity index, level of serum albumin concentration, dialyzer type and dialysis site was used to assess relative survival risk.
Two hundred and thirty patients entered the study. The mean (±sd) age of the population was 54.4 ± 14.2years, mean serum albumin concentration was 3.86 ± 0.47g/dl, mean PCR was 1.1 ± 0.28g/kg/day, and mean Kt/V 1.2 ± 0.3. Patients’ serum albumin concentration was correlated with levels of Kt/V and PCR, and their circulating IL-13 and TNF-α levels, but negatively with their circulating IL-2 levels, T-cell number and T-cell antigen recall function. T-cell antigen recall function correlated negatively with PCR, but not Kt/V. There was no correlation of any other immune parameter and medical or demographic factor. Immune parameters, however, were all highly intercorrelated. Mean level of circulating cytokines in HD patients were in all cases greater than those of a normal control group. There were few differences in medical risk factors or immune parameters between patients treated with different types of dialyzers. After an almost three-year mean follow-up period, increased IL-1, TNF-α, IL-6, and IL-13 levels were significantly associated with increased relative mortality risk, while higher levels of IL-2, IL-4, IL-5, IL-12, T-cell number and function, and CH50 were associated with improved survival. The difference in survival between patients treated with unmodified cellulose dialyzers and modified or synthetic dialyzers approached the level of statistical significance, but there were no differences in levels of circulating cytokines between these two groups.
Higher levels of circulating proinflammatory cytokines are associated with mortality, while immune parameters reflecting improved T-cell function are associated with survival in ESRD patients treated with HD, independent of other medical risk factors. These factors may serve as markers for outcome. The mechanism underlying the relationship of immune function and survival, and the effect of interventions to normalize immune function in HD patients should be studied.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9648084</pmid><doi>10.1046/j.1523-1755.1998.00981.x</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Black People chronic kidney failure cytokine Cytokines - blood Diabetic Nephropathies - immunology Diabetic Nephropathies - mortality Diabetic Nephropathies - therapy dialyzer Emergency and intensive care: renal failure. Dialysis management Female hemodialysis Humans Immune System - physiology Intensive care medicine interleukin Kidney Failure, Chronic - immunology Kidney Failure, Chronic - mortality Kidney Failure, Chronic - therapy Male Medical sciences Middle Aged Nutritional Physiological Phenomena Renal Dialysis - instrumentation Risk Factors Serum Albumin survival Survival Analysis T-cell tumor necrosis factor-α White People |
| title | Immunologic function and survival in hemodialysis patients |
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