Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, Netherlands.
Nephrology and Infectious Diseases Research and Development Group, University of Porto, Porto, Portugal.
Front Immunol. 2018 Jan 25;9:71. doi: 10.3389/fimmu.2018.00071. eCollection 2018.
Significant advances have lead to a greater understanding of the role of the complement system within nephrology. The success of the first clinically approved complement inhibitor has created renewed appreciation of complement-targeting therapeutics. Several clinical trials are currently underway to evaluate the therapeutic potential of complement inhibition in renal diseases and kidney transplantation. Although, complement has been known to be activated during dialysis for over four decades, this area of research has been neglected in recent years. Despite significant progress in biocompatibility of hemodialysis (HD) membranes and peritoneal dialysis (PD) fluids, complement activation remains an undesired effect and relevant issue. Short-term effects of complement activation include promoting inflammation and coagulation. In addition, long-term complications of dialysis, such as infection, fibrosis and cardiovascular events, are linked to the complement system. These results suggest that interventions targeting the complement system in dialysis could improve biocompatibility, dialysis efficacy, and long-term outcome. Combined with the clinical availability to safely target complement in patients, the question is not if we should inhibit complement in dialysis, but when and how. The purpose of this review is to summarize previous findings and provide a comprehensive overview of the role of the complement system in both HD and PD.
在肾脏病学领域，对补体系统作用的认识取得了重大进展。首个经临床批准的补体抑制剂的成功应用，使人们重新认识到补体靶向治疗的潜力。目前有几项临床试验正在评估补体抑制在肾脏疾病和肾移植中的治疗潜力。尽管补体在透析过程中被激活已有四十多年，但近年来这一研究领域一直被忽视。尽管血液透析（HD）膜和腹膜透析（PD）液的生物相容性取得了重大进展，但补体激活仍然是一种不良影响和相关问题。补体激活的短期影响包括促进炎症和凝血。此外，透析的长期并发症，如感染、纤维化和心血管事件，与补体系统有关。这些结果表明，针对透析中补体系统的干预措施可能会提高生物相容性、透析效果和长期预后。结合目前临床上安全靶向患者补体的可能性，问题不是我们是否应该在透析中抑制补体，而是何时以及如何进行抑制。本文综述的目的是总结以往的研究结果，并全面概述补体系统在 HD 和 PD 中的作用。
