TY - JOUR
T1 - The Complement System in Dialysis
T2 - A Forgotten Story?
AU - Poppelaars, Felix
AU - Faria, Bernardo
AU - da Costa, Mariana Gaya
AU - Franssen, Casper F. M.
AU - van Son, Willem J.
AU - Berger, Stefan P.
AU - Daha, Mohamed R.
AU - Seelen, Marc A.
PY - 2018/1/25
Y1 - 2018/1/25
N2 - Significant advances have lead to a greater understanding of the role of the complement system within nephrology. The success of the first clinically approved complement inhibitor has created renewed appreciation of complement-targeting therapeutics. Several clinical trials are currently underway to evaluate the therapeutic potential of complement inhibition in renal diseases and kidney transplantation. Although, complement has been known to be activated during dialysis for over four decades, this area of research has been neglected in recent years. Despite significant progress in biocompatibility of hemodialysis (HD) membranes and peritoneal dialysis (PD) fluids, complement activation remains an undesired effect and relevant issue. Short-term effects of complement activation include promoting inflammation and coagulation. In addition, long-term complications of dialysis, such as infection, fibrosis and cardiovascular events, are linked to the complement system. These results suggest that interventions targeting the complement system in dialysis could improve biocompatibility, dialysis efficacy, and long-term outcome. Combined with the clinical availability to safely target complement in patients, the question is not if we should inhibit complement in dialysis, but when and how. The purpose of this review is to summarize previous findings and provide a comprehensive overview of the role of the complement system in both HD and PD.
AB - Significant advances have lead to a greater understanding of the role of the complement system within nephrology. The success of the first clinically approved complement inhibitor has created renewed appreciation of complement-targeting therapeutics. Several clinical trials are currently underway to evaluate the therapeutic potential of complement inhibition in renal diseases and kidney transplantation. Although, complement has been known to be activated during dialysis for over four decades, this area of research has been neglected in recent years. Despite significant progress in biocompatibility of hemodialysis (HD) membranes and peritoneal dialysis (PD) fluids, complement activation remains an undesired effect and relevant issue. Short-term effects of complement activation include promoting inflammation and coagulation. In addition, long-term complications of dialysis, such as infection, fibrosis and cardiovascular events, are linked to the complement system. These results suggest that interventions targeting the complement system in dialysis could improve biocompatibility, dialysis efficacy, and long-term outcome. Combined with the clinical availability to safely target complement in patients, the question is not if we should inhibit complement in dialysis, but when and how. The purpose of this review is to summarize previous findings and provide a comprehensive overview of the role of the complement system in both HD and PD.
KW - complement
KW - kidney
KW - dialysis
KW - hemodialysis
KW - peritoneal dialysis
KW - MANNOSE-BINDING LECTIN
KW - REGIONAL CITRATE ANTICOAGULATION
KW - AMBULATORY PERITONEAL-DIALYSIS
KW - TO-MESENCHYMAL TRANSITION
KW - ALL-CAUSE MORTALITY
KW - HEMODIALYSIS-PATIENTS
KW - MESOTHELIAL CELLS
KW - CARDIOVASCULAR-DISEASE
KW - INFLAMMATORY RESPONSE
KW - ALTERNATIVE PATHWAY
U2 - 10.3389/fimmu.2018.00071
DO - 10.3389/fimmu.2018.00071
M3 - Review article
C2 - 29422906
SN - 1664-3224
VL - 9
JO - Frontiers in Immunology
JF - Frontiers in Immunology
M1 - 71
ER -