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. 2020 Apr 1;35(4):624-632.
doi: 10.1093/ndt/gfy276.

Uraemia-induced immune senescence and clinical outcomes in chronic kidney disease patients

Thomas Crépin  1   2   3 , Mathieu Legendre  1   2 , Clémence Carron  1 , Clément Vachey  3   4 , Cécile Courivaud  1   2   3 , Jean-Michel Rebibou  1   2 , Christophe Ferrand  1   2   5 , Caroline Laheurte  1   5 , Charline Vauchy  4 , Emilie Gaiffe  4 , Philippe Saas  1   2   4   5 , Didier Ducloux  1   2   3   4 , Jamal Bamoulid  1   2   3   4
Affiliations

Uraemia-induced immune senescence and clinical outcomes in chronic kidney disease patients

Thomas Crépin et al. Nephrol Dial Transplant. .

Abstract

Background: Patients with chronic kidney disease (CKD) are more prone to develop premature age-related diseases. Data on immune senescence are scarce in CKD populations, except in end-stage renal disease and dialysis. We designed a longitudinal prospective study to evaluate immune senescence at different CKD stages and its influence on CKD patient outcomes.

Methods: Clinical and biological data collections were performed on 222 patients at different CKD stages [1-2 (n = 85), 4 (n = 53) and 5 (n = 84)]. Immune senescence biomarkers were measured by cytometry on T cells (CD28, CD57, CD45RA, CD31, γH2A.X) or by quantitative polymerase chain reaction [relative telomere length (RTL)] on peripheral blood mononuclear cells and analysed according to CKD stages and outcomes.

Results: CKD was associated with an increase in immune senescence and inflammation biomarkers, as follows: low thymic output (197 ± 25 versus 88 ± 13 versus 73 ± 21 CD4+CD45RA+CD31+ T cells/mm3), an increased proportion of terminally differentiated T cells (CD8+CD28-CD57+) (24 ± 18 versus 32 ± 17 versus 35 ± 19%) restricted to cytomegalovirus-positive patients, telomere shortening (1.11 ± 0.36 versus 0.78 ± 0.24 versus 0.97 ± 0.21 telomere:single copy ratio) and an increase in C-reactive protein levels [median 2.9 (range 1.8-4.9) versus 5.1 (27-9.6) versus 6.2 (3.4-10.5) mg/L]. In multivariate analysis, shorter RTL was associated with death {hazard ratio [HR] 4.12 [95% confidence interval (CI) 1.44-11.75]}. Low thymic output was associated with infections [HR 1.79 (95% CI (1.34-9.58)] and terminally differentiated CD8+ T-cell expansion with a risk of cardiovascular events [CEs; HR 4.86 (95% CI 1.72-13.72)].

Conclusion: CKD was associated with premature immune ageing. Each of these alterations increased the risk of specific age-related diseases, such as RTL and death, thymic function and infections and terminally differentiated CD8+ T-cell expansion and CEs.

Keywords: chronic renal insufficiency; immune senescence; infection; telomere; thymic function.

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