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Abstract: SA-PO840

Aggravated Aging-Related Immune Changes Are Associated with Inflammation and Cardiovascular Diseases in ESRD Patients: Baseline Findings from the iESRD Study

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular


  • Shu, Kai-Hsiang, Far Eastern Memorial Hospital, New Taipei City, Taiwan
  • Peng, Yu-sen, Far Eastern memorial hospital, Taipei, Taiwan
  • Chiu, Yen-Ling, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan

Patients with end-stage renal disease (ESRD) exhibit accelerated aging of the immune system and increased risk for cardiovascular diseases, but the overall contribution of "immune system aging", or "immunosenescence" to cardiovascular disease is not clear.


We performed a comprehensive lymphocyte and monocyte immunophenotyping in 412 ESRD patients on maintenance hemodialysis and age-matched 57 healthy individuals. Peripheral bloods were sampled before hemodialysis session and processed immediately for mononuclear cell isolation and staining. Using multicolor flow cytometry, lymphocytes were separated into subpopulations including naive T cells (CCR7+CD45RA+, TNaive), central memory (CCR7+CD45RA-, TCM), effector memory (CCR7-CD45RA-, TEM), terminally differentiated (CCR7-CD45RA+, TEMRA) and memory stem cells (naive cells with high CD28 andCD95, TSCM). Monocytes were separated into classical (CD14++CD16-), intermediate (CD14++CD16+) and non-classical monocytes (CD14+CD16+).


Compared to healthy individuals, ESRD patients showed decreased levels of naive CD4+ and CD8+ T cells, increased levels of terminally differentiated TEMRA cells and intermediate monocytes (CD14++CD16+), and these changes not only significantly correlated with age but also enhanced by increasing dialysis vintage. Lymphocyte and monocyte aging also correlated with other established cardiovascular risk factors, including hemoglobin and high-sensitivity C-reactive protein. In multivariate-adjusted logistic regression models, a high terminally differentiated CD8+ TEMRA cell level in combination with a high intermediate monocyte level was independently associated with the existence of coronary artery disease (OR=2.29, 95% CI=1.2~4.5, p=0.016) as well as cardiovascular diseases including stroke and peripheral arterial occlusive disease (OR=2.32, 95% CI=1.2~4.4, p=0.008).


Aging-related changes in the immune system are significantly aggravated in ESRD. Cardiovascular disease burden in the ESRD population might be enhanced by the presence of accelerated aging-related immune changes.