Patients with
chronic renal failure show an immunodeficiency characterized by frequent infectious complications and a low response to vaccinations. This is paralleled in vitro by a low T-cell proliferation on mitogenic stimuli because of an impaired costimulation by accessory cells. Furthermore, alterations of the
cytokine profile are correlated with impaired immune function. The immune system is influenced by both
uremia and
renal replacement therapy. To evaluate the influence of
hemodialysis on immune parameters, we studied patients before and after the initiation of chronic
hemodialysis therapy. Fourteen patients with
end-stage renal failure were tested before dialysis initiation and during the first 6 weeks of
hemodialysis treatment. We determined the in vitro T-cell proliferation, as well as plasma levels of
interleukin-6 (IL-6) and the release of
IL-6 and
IL-10 into culture supernatant poststimulation with
lipopolysaccharide. After 6 weeks of intermittent
hemodialysis, in vitro T-cell proliferation on stimulation improved significantly (stimulation index, 21.6 +/- 18.5 versus 58.1 +/- 45.5; P < 0.01). This improvement occurred regardless of whether synthetic dialyzers or cellulosic membranes were used for the initiation of dialysis. Plasma
IL-6 levels, as well as
IL-6 and
IL-10 secretion, did not change during the study period. In patients with
end-stage renal disease, the initiation of
hemodialysis led to a significant improvement of in vitro T-cell proliferation. This effect may have a role for an improvement of immune function in vivo. The expected normalization of
IL-6 and
IL-10 production may be masked by
cytokine induction through
hemodialysis membranes.