Impact of anemia treatment with methoxy polyethylene glycol-epoetin beta on polymorphonuclear cells apoptosis in predialysis patients with chronic kidney disease

Neutrophil Function in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Patients with chronic kidney disease (CKD) are at increased cardiovascular risk. Since neutrophils play a central role in atherosclerosis and cardiovascular disease, this study analyzed neutrophil function in CKD patients.

METHODS

A systematic review of neutrophil function in CKD patients compared to controls was performed according to PRISMA guidelines by searching PubMed and the Web of Science. A meta-analysis summarized the production of reactive oxygen species (ROS) in CKD patients on dialysis in Forest plots. Influencer outlier analyses evaluated risk of bias.

RESULTS

Overall, 92 studies were included, of which 18 in the meta-analysis. Although study heterogeneity was high, the systematic review identified primarily reduced phagocytosis capacity but increased neutrophil degranulation and basal ROS production in neutrophils from CKD patients on hemodialysis compared to controls. Phagocytosis and basal ROS production were mainly unaltered in non-dialysis dependent CKD patients and CKD patients on peritoneal dialysis. The meta-analysis confirmed increased ROS generation in basal conditions predominantly in CKD patients on hemodialysis (Hedges g = 1.20, 95% CI: [0.32; 2.09]), with an insufficient study number for a clear comparison to CKD patients on peritoneal dialysis. However, upon neutrophil stimulation with sterile inflammatory triggers, ROS production was also increased in neutrophils from patients on peritoneal dialysis (Hedges g = 0.89, 95% CI: [0.34; 1.43]).

CONCLUSION

Increased degranulation and basal ROS formation were observed in neutrophils of CKD patients on hemodialysis, which could contribute to their increased cardiovascular risk. Future studies should compare neutrophil activity in patients of different CKD stages and comorbidities also in relation to cardiovascular outcomes.

NETs-Induced Thrombosis Impacts on Cardiovascular and Chronic Kidney Disease

Arterial and venous thrombosis constitute a major source of morbidity and mortality worldwide. Association between thrombotic complications and cardiovascular and other chronic inflammatory diseases are well described. Inflammation and subsequent initiation of thrombotic events, termed immunothrombosis, also receive growing attention but are still incompletely understood. Nevertheless, the clinical relevance of aberrant immunothrombosis, referred to as thromboinflammation, is evident by an increased risk of thrombosis and cardiovascular events in patients with inflammatory or infectious diseases. Proinflammatory mediators released from platelets, complement activation, and the formation of NETs (neutrophil extracellular traps) initiate and foster immunothrombosis. In this review, we highlight and discuss prominent and emerging interrelationships and functions between NETs and other mediators in immunothrombosis in cardiovascular disease. Also, with patients with chronic kidney disease suffering from increased cardiovascular and thrombotic risk, we summarize current knowledge on neutrophil phenotype, function, and NET formation in chronic kidney disease. In addition, we elaborate on therapeutic targeting of NETs-induced immunothrombosis. A better understanding of the functional relevance of antithrombotic mediators which do not increase bleeding risk may provide opportunities for successful therapeutic interventions to reduce thrombotic risk beyond current treatment options.

Impact of Continuous Erythropoietin Receptor Activator on Selected Biomarkers of Cardiovascular Disease and Left Ventricle Structure and Function in Chronic Kidney Disease

Background. Cardiovascular morbidity and mortality are very high in patients with chronic kidney disease (CKD). The purpose of this study is to evaluate the impact of continuous erythropoietin receptor activator (CERA) on selected biomarkers of cardiovascular disease, left ventricle structure, and function in CKD. Material and Methods. Peripheral blood was collected from 25 CKD patients before and after CERA treatment and 20 healthy subjects. In serum samples, we assessed inflammatory markers (IL-1β, TNF-RI, TNF-RII, sFas, sFasL, MMP-9, TIMP-1, and TGF-β1), endothelial dysfunction markers (sE-selectin, sICAM-1, and sVCAM-1), and volume-related marker (NT-proBNP). All subjects underwent echocardiography and were evaluated for selected biochemical parameters (Hb, creatinine, and CRP). Results. Evaluated biomarkers and echocardiographic parameters of left ventricle structure were significantly increased but left ventricle EF was significantly decreased in CKD patients compared to controls. After CERA treatment, we observed a significant increase of Hb and left ventricle EF and a significant decrease of NT-proBNP and MMP-9. There was a significant negative correlation between Hb and TNF-RI, sICAM-1, and IL-1β. Conclusions. Our results indicate that selected biomarkers related to cardiovascular risk are significantly increased in CKD patients compared to controls. CERA treatment has anti-inflammatory action, diminishes endothelial dysfunction, and improves left ventricle function in these patients.