Peripheral blood lymphocyte subgroups in patients undergoing hemodialysis with medium cutoff membranes and high-flux membranes: THE SHE continuation study

Abstract

Introduction: Chronic kidney disease (CKD) poses a significant global health burden, with increasing prevalence and high morbidity and mortality rates, particularly in end-stage kidney disease (ESKD). While traditional risk factors contribute, the exact mechanisms remain elusive, with inflammation playing a pivotal role. Medium cutoff (MCO) membranes offer promise in improving dialysis outcomes by efficiently clearing uremic toxins without substantial albumin loss. We aimed to elucidate the impact of MCO and high-flux (HF) membranes on peripheral blood lymphocyte subpopulations in hemodialysis patients. Methods: Twenty-four ESKD patients underwent 36 sessions each with MCO and HF membranes. Immunophenotyping by flow cytometry was performed to analyze lymphocyte subsets. Results: NK cell percentages significantly increased with MCO, returning to baseline with HF. Th1 cells decreased post-HF, while Th2 and Tfh cells increased with MCO and persisted. Treg cells remained stable with MCO but decreased with HF. Conclusion: MCO dialysis induced an anti-inflammatory shift, evidenced by increased Th2 and Tfh cells and stable Treg cells. NK cells also responded favorably to MCO. These findings underscore MCO membranes’ potential to modulate immune responses and improve patient outcomes in ESKD.