Journal Article

Patterns of CD4/CD8 T‐cell ratio in dialysis effluents predict the long‐term outcome of peritonitis in patients undergoing peritoneal dialysis

Hsin‐Hui Wang, Ching‐Yuang Lin and Tung‐Po Huang

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 6, pages 1181-1189
Published in print June 2003 | ISSN: 0931-0509
Published online June 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg079
Patterns of CD4/CD8 T‐cell ratio in dialysis effluents predict the long‐term outcome of peritonitis in patients undergoing peritoneal dialysis

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Background. The peritoneal immune compartment is a microenvironment with a particular T‐cell repertoire and susceptible to local inflammation. To clarify the role of T lymphocytes in peritoneal immunity, the changes in T‐cell subpopulations in peritoneal dialysis effluents (PDEs), and their influence on the response to the treatment of peritonitis and on its prognosis were studied in patients undergoing long‐term, continuous ambulatory peritoneal dialysis (CAPD).

Methods. A cohort of 36 patients treated with CAPD and who had histories of peritonitis were divided into a group with rapid and a group with delayed response to antibiotics, and were followed for 3 years. CD4/CD8 T‐cell ratios, T‐cell cytokine mRNA expression patterns and transforming growth factor‐β1 (TGF‐β1) concentrations were examined in PDE during bouts of peritonitis. The change in 4 h D/P creatinine during the peritoneal equilibration test (PET) between year 0 and year 3 was expressed as ΔD/P creatinine.

Results. The serial changes in T‐cell subsets in PDE during peritonitis showed two patterns: (i) pattern 1, manifest as a progressive increase in the CD4/CD8 ratio, and associated with a rapid response to treatment; and (ii) pattern 2, manifest as a progressive decrease in the CD4/CD8 ratio, and associated with a delayed response to treatment. The major T‐cell phenotypes in PDE during peritonitis were Th1‐CD4+ and Tc2‐CD8+, determined by cloning techniques, RT–PCR and double immunofluorescence staining. TGF‐β1 in the effluent was undetectable in pattern 1 after 7–8 days, but remained detectable at 2 weeks in pattern 2. Pattern 2 patients had a significantly greater decrease (ΔD/P creatinine: −0.198±0.086) in solute transport than pattern 1 patients (ΔD/P creatinine: −0.036±0.077, P<0.05).

Conclusions. These results suggest that a progressive decrease of the CD4/CD8 ratio in PDE correlates with a persistent expression of TGF‐β1, and plays a pathogenetic role in the evolution of peritonitis, PET deterioration and peritoneal fibrosis. Therefore, patterns of CD4/CD8 T‐cell ratio in PDE may predict clinical outcomes of peritonitis in CAPD patients.

Keywords: CD4+ T cells; CD8+ T cells; peritoneal dialysis; peritonitis; TGF‐β1

Journal Article.  6143 words.  Illustrated.

Subjects: Nephrology

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