Shen Yuli, Schmaderer Christoph, Ossadnik Andreas, Hammitzsch Arianne, Carbajo-Lozoya Javier, Bachmann Quirin, Bonell Vera, Braunisch Matthias Christoph, Heemann Uwe, Pham Dang, Kemmner Stephan, Lorenz Georg
Department of Nephrology, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany.
Nephrology and Rheumatology Department of the Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen 518172, China.
Int J Nephrol. 2023 Sep 27;2023:7772677. doi: 10.1155/2023/7772677. eCollection 2023.
Due to chronic inflammation, maintenance hemodialysis (MHD) patients continue to show excess mortality. Acetate-free citrate-buffered A concentrates could be a way to improve the biocompatibility of the procedure, reduce chronic inflammation, and thus in the long term improve the prognosis of patients.
Using a pre-post design (3 months of acetate followed by 3 months of citrate-acidified A concentrates in standard bicarbonate-based dialysate hemodialysis, CiaHD) and linear mixed model analysis in 61 stable HD patients, we assessed the impact of CiaHD on counts and phenotypes of peripheral T cells and monocytes by flow cytometry.
Switching to CiaHD left C-reactive protein (CRP) levels and leucocyte counts unaffected. However, CiaHD increased lymphocyte counts ex vivo. Furthermore, we found a decrease in total CD3+CD4+CD69+ ((10/L), mean ± SD: acetate, 0.04 ± 1.0 versus citrate, 0.02 ± 0.01; = 0.02) activated cells, while the number of CD28+ T cells remained stable. No differences were noted regarding T-cell exhaustion marker expression, CD14+CD16+ monocyte counts, and PMN-MDSCs.
Compared with acetate, CiaHD has a minor impact on lymphocyte counts and CD4+T-cell activation, which was independent of systemic CRP and ionized magnesium, calcium levels, and other dialysis prescription modalities.
由于慢性炎症，维持性血液透析（MHD）患者的死亡率持续偏高。无醋酸盐的柠檬酸盐缓冲A浓缩液可能是一种改善该治疗生物相容性、减轻慢性炎症从而从长远改善患者预后的方法。
采用前后设计（3个月使用醋酸盐，随后3个月在标准碳酸氢盐透析液血液透析（CiaHD）中使用柠檬酸酸化的A浓缩液），并对61例稳定的血液透析患者进行线性混合模型分析，我们通过流式细胞术评估了CiaHD对外周血T细胞和单核细胞计数及表型的影响。
改用CiaHD后，C反应蛋白（CRP）水平和白细胞计数未受影响。然而，CiaHD在体外增加了淋巴细胞计数。此外，我们发现总CD3 + CD4 + CD69 +（每升，平均值±标准差：醋酸盐，0.04±1.0；柠檬酸盐，0.02±0.01；P = 0.02）活化细胞数量减少，而CD28 + T细胞数量保持稳定。在T细胞耗竭标志物表达、CD14 + CD16 +单核细胞计数和PMN-MDSCs方面未发现差异。
与醋酸盐相比，CiaHD对淋巴细胞计数和CD4 + T细胞活化的影响较小，这与全身CRP、离子化镁、钙水平及其他透析处方方式无关。
