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Frontiers Media, Frontiers in Medicine, (8), 2021

DOI: 10.3389/fmed.2021.742419

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T-Lymphocyte Subsets Alteration, Infection and Renal Outcome in Advanced Chronic Kidney Disease

Journal article published in 2021 by Jiachuan Xiong, Yu Qiao, Zhikai Yu, Yinghui Huang, Ke Yang, Ting He, Jinghong Zhao
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Background:T-lymphocyte subsets reflect patients' immune status and are associated with adverse outcomes in various diseases. However, the association between T-lymphocyte subsets and major infection and renal outcome in chronic kidney disease (CKD) patients has not been well-addressed.Methods:Patients diagnosed with stage 3–5 of non-dialysis CKD were recruited, and healthy subjects were selected as the controls. T-lymphocyte subsets (CD3+, CD4+, CD8+) were detected by flow cytometry, and the CD4+/CD8+T cell ratio was then calculated. Patients were divided into the normal-level group and the low-level group according to the clinical reference value. The primary outcomes were the major infection and renal outcome.Results:A total of 410 CKD patients were enrolled; the average age was 47.25 years. Compared to the healthy controls, the level of CD3+, CD4+, CD8+T cells, and the CD4+/CD8+T cell ratio were significantly decreased in CKD patients (p< 0.05). During the median follow-up of 2.56 (quartile interval 1.24–3.46) years, major infections occurred in 15.10% of the CKD patients. The incidence of infection was significantly higher in the low-level group of CD3+, CD4+T cells, and CD4+/CD8+T cell ratio compared with the normal level groups. Kaplan-Meier analysis showed that the lower level of CD3+, CD4+T cells, and CD4+/CD8+T cell ratio is associated with a greater risk of infection. Cox regression analysis further confirmed that low CD3+, CD4+T cells, and CD4+/CD8+T cell ratio were independent risk factors of infection in CKD patients. Moreover, during the follow-up, renal events occurred in 37.50% of patients. Kaplan-Meier analysis indicated that low levels of CD3+, CD4+, and CD8+T cells are significantly associated with renal outcome in CKD patients. Cox regression analysis showed that low level of CD3+T cells (HR = 2.407, 95% CI: 1.664–3.482,p< 0.001), CD4+T cells (HR = 2.397, 95% CI: 1.633–3.518,p< 0.001) and CD8+T cells (HR = 2.416, 95% CI: 1.476–3.955,p< 0.001) were independent risk factors for renal outcome after multivariable-adjusted.Conclusion:CKD patients had a defect in T-lymphocyte subpopulation. T-lymphocyte subsets were closely associated with infection and renal outcome in CKD patients. Suggesting T-lymphocyte subsets are independent predictors of infection and renal outcome in CKD patients.