Reduction of T cell subpopulations peripheral blood is a predictor of renal endpoint events in patients with chronic kidney disease

Abstract

Objective To investigate the correlation between the counts of CD3+, CD4+, and CD8+ T cells in peripheral blood as well as the ratio of CD4+/CD8+ T cells and the renal endpoint events (renal substitutive therapy) in patients with chronic kidney disease (CKD), and to determine whether these T cell parameters are prognostic indicators for pre-dialysis CKD patients. Methods A total of 568 pre-dialysis patients with primary CKD at stage 3~5 admitted in our hospital from March 2015 to January 2019 were enrolled and followed up in this study. Immunofluorescence flow cytometry was adopted to detect the counts of CD3+, CD4+ and CD8+ T cells, and the ratio of CD4+/CD8+ T cells was calculated. The CKD patients then were divided into normal- and low-level groups of CD3+, CD4+ and CD8+ T cell counts, according to the clinical reference values. The renal endpoint event was defined as initiation of a renal substitutive therapy duo to irreversible deterioration of kidney function, including peritoneal dialysis, hemodialysis, and kidney transplantation. Kaplan-Meier analysis was used to compare the survival time between the 2 groups. Cox regression model was adopted to analyze the risk factors associated with CKD progression. Results There were eventually 240 patients (42.25%) receiving renal substitutive therapy during a mean follow-up of 2.25 years. Kaplan-Meier analysis showed that lower counts of CD3+, CD4+ and CD8+ T cells were independently associated with higher occurrence of the renal endpoint events. Cox regression model suggested that the low-level groups of the above 3 kinds of T cells had significantly higher risks in progression into the endpoint events (HR=1.575, 1.511, 1.583). After multivariable adjustment, the risk of the endpoint events remained increased in patients from the low-level group (HR=1.803, 1.945, 2.010). Conclusion The reduction of CD3+, CD4+ and CD8+ T cells in peripheral blood is closely related to the occurrence of renal substitutive therapy, which might be used as a predictive factor of renal outcome for CKD patients at pre-dialysis stage 3~5.

Keywords

• chronic kidney disease
• t lymphocyte subpopulation
• renal endpoint events