Immune Dysfunction and Risk of Infection in Chronic Kidney Disease

Adv Chronic Kidney Dis. 2019 Jan;26(1):8-15. doi: 10.1053/j.ackd.2019.01.004.

Abstract

Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response. On the other hand, an abnormal, exaggerated reaction of the immune systems can also occur in this group of patients, resulting in increased production and decreased clearance of proinflammatory cytokines, which can lead to inflammation and its sequelae (eg, atherosclerotic cardiovascular disease). Epigenetically, modifications in hematopoietic stem cells involving a shift from lymphoid to myeloid cell lineage may underlie uremia-associated immunological senescence, which is not reversed by renal replacement therapy, including kidney transplantation. Measures aimed at attenuating the immune abnormalities in chronic kidney disease/end-stage renal disease should be an area of focused research as this could potentially lead to a better understanding and, thus, development of therapies that could reduce the disastrously high death rate in this patient population. The aim of the present article is to review the characteristics, causes, and mechanisms of the immune dysfunction related to chronic kidney disease.

Keywords: Chronic kidney disease; Immune dysfunction; Infection; Inflammation; Uremic toxicity.

Publication types

  • Review

MeSH terms

  • Adaptive Immunity / immunology
  • Calcitriol / immunology
  • Calcium / metabolism
  • Epigenesis, Genetic
  • Erythropoietin / immunology
  • Fibroblast Growth Factors / metabolism
  • Gastrointestinal Microbiome / immunology
  • Hematopoietic Stem Cells / metabolism
  • Humans
  • Immunity, Innate / immunology
  • Immunocompromised Host / genetics
  • Immunocompromised Host / immunology*
  • Immunosenescence
  • Infections / epidemiology
  • Infections / immunology*
  • Inflammation / immunology*
  • Iron / immunology
  • Oxidative Stress / immunology
  • Parathyroid Hormone / metabolism
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / genetics
  • Renal Insufficiency, Chronic / immunology*
  • Renal Insufficiency, Chronic / therapy
  • Renal Replacement Therapy
  • Renin / immunology
  • Renin-Angiotensin System / immunology
  • Vitamin D / metabolism

Substances

  • Parathyroid Hormone
  • Erythropoietin
  • Vitamin D
  • Fibroblast Growth Factors
  • fibroblast growth factor 23
  • Iron
  • Renin
  • Calcitriol
  • Calcium