MP446CD4 LYMPHOPENIA IS ASSOCIATED WITH AORTIC ARCH CALCIFICATION IN PATIENTS WITH END-STAGE RENAL DISEASE

Abstract

INTRODUCTION AND AIMS: Vascular calcification is preceded by atherosclerosis and/or chronic kidney disease-mineral and bone disorder (CKD-BMD) in patients with end-stage renal disease (ESRD). All-cause and cardiovascular mortality can be predicted from the degree of aortic arch calcification on chest X-rays. The T cell phenotype is associated with cardiovascular disease (CVD) and T-cell infiltration is thought to be involved in vascular calcification sites. However the association between T cell phenotype and vascular calcification remains unclear. METHODS: We enrolled 71 patients with ESRD (mean age 67.9 ± 12.5 years; male, 45 [63%]; dialysis, 31 [44%]) and CKD 5 or 5D who were hospitalized between June 2012 and December 2016. The patients were assigned to groups depending on whether they had absent - slight or moderate - severe aortic arch calcification (AAC) on chest Xrays. We also determined the numbers of immune cell phenotypes (CD3+, CD4+, CD8+, CD28+CD8+) and the ratio of CD4/CD8 cells in peripheral blood mononuclear cells using flow cytometry to define their relationships with AAC. RESULTS: Among 41 (56%) patients with moderate - severe aortic arch calcification, the numbers of CD3+ (723 vs. 911, p = 0.015) and CD4+ (435 vs. 588, p = 0.003) cells were significantly lower and this group was significantly older (age 72 vs. 62 y, p < 0.001) than the group with absent or slight AAC. However, multivariate logistic analysis corrected for dialysis, Log CRP, age, and cardiovascular complications significantly associated only the number of CD4+ T cells (odds ratio, 0.997; 95% confidence interval, 0.994 - 1.000, p=0.027) with AAC. CONCLUSIONS: Peripheral blood CD4 lymphopenia is associated with AAC in patients with ESRD.