Immunological features of ESRD patients undergoing hemodialysis of various ages

Aims To investigate the immunological characteristics of hemodialysis (HD) patients with end-stage renal disease (ESRD) of various ages, and the impact of age-related immune alterations on these patients, with a focus on peripheral T cells. Methods From September 2016 to September 2019, HD patients were enrolled and followed prospectively for 3 years. Patients were divided into three groups based on their ages: < 45, 45 to 64, and >= 65. The distribution of T cell subsets in different age groups was investigated and compared. The effects of altered T cell subsets on overall survival were also investigated. Results A total of 371 HD patients were enrolled. The reduced number of naive CD8+ T cells ( P < 0.001) and increased number of EMRA CD8+ T cells (P = 0.024) were independently associated with the advanced age among all T cell subsets studied. Patient survival may be affected by numerical changes in naive CD8+ T cells. However, when HD patients were < 45 or >= 65 years, the reduction had no significant impact on survival. Only in HD patients aged 45 to 64 years, the number of naive CD8+ T cells found to be insufficient but not deficient, identified as an independent predictor of poor survival. Conclusions The most significant age-related immune change in HD patients was a decrease in peripheral naive CD8+ T cells, which was an independent predictor of 3-year overall survival in HD patients aged 45 - 64 years.