Influence of uraemia and haemodialysis on host defence and infection

Dysfunction of the host defence is one of the major functional disturbances in end-stage renal disease (ESRD) with substantial clinical and socioeconomic implications. The resulting higher susceptibility to infection may lead to life-threatening complications such as sepsis, septic shock, and abcess formation. The immune system defends against infection via a cascade of finely tuned mechanisms, which include (1) the functional involvement of immunocompetent cells, (2) the release of humoral substances upgrading immunocompetence, and (3) the attraction of cells towards regions of infection. All these elements cooperate to achieve ingestion and destruction of infectious agents by phagocytic cells. The effect of uraemia (and its treatment by dialysis) on the immune system will be considered in depth, to formulate therapeutic approaches and preventive measures.