Resumen de Immunological landscape in chronic kidney disease (CKD): insights into lymphocyte dynamics, complement activation, and inflammatory profiles
María Gabriela Ortiz Díaz, Maria del Mar Rodríguez San Pedro, Gemma Valera Arévalo, Jara Caro, Enrique Morales Ruiz, Julia Carracedo Añón, Natalia Guerra Pérez, Rafael Ramírez Carracedo
Chronic kidney disease (CKD) is a progressive disorder marked by a declining renal function and a profound immune dysregulation, predisposing patients to infections, systemic inflammation, and cardiovascular complications. Among the most relevant immunological disturbances, alterations in lymphocyte subpopulations, fluctuations in inflammatory markers such as C-reactive protein (CRP) and serum albumin, and variations in complement system components (C3 and C4) have been closely linked to disease progression and therapeutic responses. In this study, we examined a cohort of 187 CKD patients categorized into five groups: control (CT), advanced chronic kidney disease (ACKD), peritoneal dialysis (PD), haemodialysis (HD), and kidney transplant recipients (TX). Peripheral blood samples were obtained from the Department of Nephrology at Hospital 12 de Octubre in Madrid. Lymphocyte subpopulations were analysed using flow cytometry, while CRP, serum albumin, and complement proteins (C3 and C4) were quantified via nephelometry. Statistical analyses, conducted using SPSS software, explored correlations between these immunological parameters and CKD severity. Our findings demonstrated a pronounced reduction in CD4+ and CD8+ T cell counts in advanced CKD and in patients undergoing dialysis, accompanied by stage-dependent variations in B cell populations. Inflammatory markers strongly correlated with disease severity, as indicated by increased CRP levels and reduced serum albumin concentrations. Furthermore, complement proteins C3 and C4 exhibited distinct fluctuations across CKD stages and treatment groups, implicating their role in immune dysregulation associated with the disease. Notably, in most cases, these immunological disturbances were mitigated in kidney transplant recipients, reinforcing transplantation as the preferred therapeutic approach whenever feasible. These results underscore the complex immunological landscape of CKD and emphasize the value of immune monitoring as a potential tool for disease evaluation and therapeutic guidance. Further studies should investigate targeted immunomodulatory interventions to counteract immune dysfunction and improve patient outcomes.
