Key result
In patients with type 2 cardiorenal syndrome, higher CD4+ T-lymphocyte levels independently predicted lower risk of all-cause and cardiovascular mortality (OR 0.66 per 100 cells/μL increase).
Why the study?
Maladaptive activation of the immune system plays a key role in the pathogenesis of chronic kidney disease, motivating investigation into differences in circulating immune cells between type 2 cardiorenal syndrome patients and CKD patients without cardiovascular disease.
Do circulating immune cell subsets, such as CD4+ T-lymphocytes, predict mortality in patients with type 2 cardiorenal syndrome?
Cohort (n=63)
No
Do circulating immune cell subsets, such as CD4+ T-lymphocytes, predict mortality in patients with type 2 cardiorenal syndrome?
Odds Ratio: 0.66 (95% CI 0.5–0.87)
p-value: p=0.004
Higher levels of CD4+ T-lymphocytes are associated with better survival in patients with type 2 cardiorenal syndrome, suggesting a potential role for immune profiling in risk stratification.
CD4+ T-cell monitoring should not yet change practice in type 2 cardiorenal syndrome; hypothesis-generating for immune profiling in prognosis.
Maladaptive activation of the immune system plays a key role in the pathogenesis of chronic kidney disease (CKD). Our aim was to investigate differences in circulating immune cells between type 2 cardiorenal syndrome (CRS-2) patients and CKD patients without cardiovascular disease (CVD). CRS-2 patients were prospectively followed up, with the primary endpoint being all-cause and cardiovascular mortality. Method: A total of 39 stable males with CRS-2 and 24 male CKD patients matched for eGFR (CKD-EPI) were enrolled. A selected panel of immune cell subsets was measured by flow cytometry. Results: Compared to CKD patients, CRS-2 patients displayed higher levels of proinflammatory CD14++CD16+ monocytes (p = 0.04) and T regulatory cells (Tregs) (p = 0.03), lower lymphocytes (p = 0.04), and lower natural killer cells (p = 0.001). Decreased lymphocytes, T-lymphocytes, CD4+ T-cells, CD8+ T-cells, Tregs, and increased CD14++CD16+ monocytes were associated with mortality at a median follow-up of 30 months (p < 0.05 for all). In a multivariate model including all six immune cell subsets, only CD4+ T-lymphocytes remained independent predictors of mortality (OR 0.66; 95% CI 0.50–0.87; p = 0.004). Conclusion: Patients with CRS-2 exhibit alterations in immune cell profile compared to CKD patients of similar kidney function but without CVD. In the CRS-2 cohort, CD4+ T-lymphocytes independently predicted fatal cardiovascular events.
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Duni et al. (2023) conducted a cohort in Type 2 Cardiorenal Syndrome and Chronic Kidney Disease (n=63). CD4+ T-lymphocyte levels was evaluated on All-cause and cardiovascular mortality (OR 0.66 per 100 cells/μL increase, 95% CI 0.50-0.87, p=0.004). In patients with type 2 cardiorenal syndrome, higher CD4+ T-lymphocyte levels independently predicted lower risk of all-cause and cardiovascular mortality (OR 0.66 per 100 cells/μL increase).
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