Monocytes in Uremia

Abstract

Monocytes play an important role in both innate immunity and antigen presentation for specific cellular immune defense. In patients with chronic renal failure, as well as those treated with maintenance hemodialysis, these cells are largely dysregulated. There is a large body of literature on monocyte alterations in such patients. However, most of the publications report on small series, there is a vast spectrum of different methods and the heterogeneity of the data prevents any meta-analytic approach. Thus, a narrative review was performed to describe the current knowledge. Monocytes from patients with chronic renal failure differ from those of healthy individuals in the pattern of surface molecule expression, cytokine and mediator production, and function. If these findings can be summarized at all, they might be subsumed as showing chronic inflammation in resting cells together with limited activation upon immunologic challenge. The picture is complicated by the fact that monocytes fall into morphologically and functionally different populations and population shifts interact heavily with dysregulation of the individual cells. Severe complications of chronic renal failure such as impaired immune defense, inflammation, and atherosclerosis can be related to several aspects of monocyte dysfunction. Therefore, this review aims to provide an overview about the impairment and activation of monocytes by uremia and the resulting clinical consequences for renal failure patients.

Keywords: chronic kidney disease; cytokines; hemodialysis; inflammation; monocytes; uremic toxins.

Figure 1

Flow cytometry panel showing gating strategy of monocytes of an uremic patient by anti-CD86 staining and subdivision of monocytes in classical (Mo1), intermediate (Mo2) and non-classical Mo3 according anti-CD14/CD16 staining. R1 includes CD86+ monocytes.

Figure 2

Time course of circulating Mo3 cell numbers during dialysis sessions (Data from: [105]).