#6158 UREMIC TOXINS ARE ASSOCIATED WITH IMMUNE-SENESCENCE AND IMMUNE-EXHAUSTION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Immune-senescence exhaustion have been described in hemodialysis (HD) patients, with changes lymphocyte phenotype possibly stimulated by the uremic environment, independent of age comorbid conditions. We evaluated potential association toxin accumulation count HD patients. Method In peripheral blood 54 patients (23 female, mean 51.3±16.91 years) 31 age-matched healthy controls, lymphocytes surface molecules were determined flow cytometry: T cells (CD4, CD8, CD31, CD45RA, CCR7, CD28, CD57, PD1) B (CD27, IgD). Plasma levels protein bound toxins [hippuric acid (HA), indoxyl sulfate (IxS) p-cresyl (pCS)] measured ultra-performance liquid chromatography. Lymphocyte phenotypes correlated using Spearman's correlation coefficient test. Patients recent or active infection, malignancy, autoimmune disease and/or diabetes mellitus excluded. Results A higher concentration was observed compared to namely: total HA 3.05 (1.66-5.37) vs 0.102 (0.04-0.2)mg/dl (p<0.001), free 1.482 (0.7-2.8) 0.029 (0.03-0.04)mg/dl (p<0.001); IxS 2.207 (1.27-3.34) 0.063 (0.04-0.09)mg/dl 0.146 (0.09-0.27) 0.0004 (0.0004-0.0004)mg/dl pCS 1.248 (0.84-1.66) 0.066 (0.04-0.13)mg/dl 0.089 (0.06-0.13) 0.004 (0.004-0.005)mg/dl respectively. There a positive between vintage as well (p = 0.005, p 0.003, respectively). No significant differences found according sex, age, dialysis prescription method. residual urine output had reduced 1.739 (3.5) 3.347 (4.16)mg/dl 0.03), 0.717 (1.9) 1.901 (3.5)mg/dl 0.04), respectively levels, 0.117 (0.1) 0.177 (0.2)mg/dl 0.02), Total absolute number CD4 negatively 0.018 0.02 respectively) 0.024 0.017 Several naïve less differentiated subpopulations also demonstrated negative most importantly CD4CD31+ 0.037 0.027 respectively), CD8CD28+CD57- 0,014 CD4CD45+CD57- 0.039 (CD19+IgD+CD27-) 0.042 0.032 Advanced subtypes, CD4CD28+CD57+ CD4CD45-CD57+ ΗΑ 0.036 0.045 Exhausted cells, defined CD4+PD1+ correlations 0.011 but not levels. Moreover, further divided exhausted lymphocytes, CD45RA expression, CD4CD45RA-PD1+ positively 0.01 CD4CD45RA+PD1+ Conclusion Uremic are increased may influence adaptive immunity. is associated an immune-senescent, while immune-exhausted phenotype.