End-Stage Renal Disease-Related Accelerated Immune Senescence: Is Rejuvenation of the Immune System a Therapeutic Goal?

Abstract

End-stage renal disease (ESRD) patients exhibit clinical features of premature ageing, including frailty, cardiovascular disease, and muscle wasting. Accelerated ageing also concerns the immune system. Patients with ESRD have both immune senescence and chronic inflammation that are resumed in the so-called inflammaging syndrome. Immune senescence is particularly characterised by premature loss of thymic function that is associated with hyporesponsiveness to vaccines, susceptibility to infections, and death. ESRD-related chronic inflammation has multiple causes and participates to accelerated cardiovascular disease. Although, both characterisation of immune senescence and its consequences are relatively well-known, mechanisms are more uncertain. However, prevention of immune senescence/inflammation or/and rejuvenation of the immune system are major goal to ameliorate clinical outcomes of ESRD patients.

Keywords: end-stage renal disease; immune senescence; inflammaging; kidney transplantation; thymus.

Figure 1

End-stage renal disease-related inflammaging: main causes and potential consequences. CMV, Cytomegalovirus; SASP, senescence-associated secretory phenotype.

Figure 2

Potential therapeutic interventions to prevent or reverse end-stage renal disease-related inflammaging. Black, interventions with evidences; Blue, interventions without clinical evidence but with strong background and potentiality; Red, interventions with evidences of inefficacy.