Inflammation parameters, monocyte subgroups and toll-like receptor expression before and after dialysis in patients with chronic kidney disease

Abstract

Objectives: The data of the monocyte subgroups and expressed toll like receptors (TLR) in the innate immune system response, which develop against chronic inflammation in patients with predialysis chronic kidney disease (CKD) and in patients who undergo dialysis treatment, are limited. We aimed to investigate the effect of the dialysis procedure on the current chronic inflammatory condition and which role of monocyte subgroups ratios, the expressions of TLR2/4 and serum Tumor necrosis factor alpha (TNF-alpha) levels involved in the innate immune response process.Methods: We investigated monocyte subgroups, TLR2/TLR4 expressions and serum TNF-alpha levels in 30 predialysis CKD patients, 90 CKD patients undergoing dialysis and 30 healthy control subjects. Monocyte subgroup percentages and TLR2/TLR4 expressions were determined using the flow cytometry, serum TNF-alpha levels were investigated using the enzyme-linked immunosorbent assay (ELISA).Results: In the dialysis patients, the percentages of classical (p=0.0001) and non-classical (p=0.078) monocytes were found to be higher when compared with the predialysis CKD patients. The percentages of TLR4 expression on non-classical monocytes was higher in dialysis and predialysis patients compared with the healthy controls (p < 0.0001, p=0.796). Serum TNF-alpha level was significantly higher in dialysis and predialysis patients compared with the healthy controls (p=0.013, p=0.022) and a positive correlation between the classical monocyte subgroup and TNF-alpha was observed (r=0.285, p=0.006).Conclusions: Increased percentages of non-classical monocytes, TLR4 expressions and serum TNF-alpha levels observed in the predialysis CKD patients and dialysis patients might be related to inflammation.