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CMV Seropositivity Determines Epoetin Dose and Hemoglobin Levels in Patients with CKD
Journal of the American Society of Nephrology, 10/12/09

Betjes MGH et al. – Expansion of CD4+CD28null T cells in CMV–seropositive patients with ESRD associates with increased demand for epoetin.

Exclusive Author Commentary
Michiel G.H. Betjes, 10/14/09

Most individuals become infected with CMV early in life after which the virus goes in latency. However, the impact of CMV latency on the T cell part of the immune system is substantial, and even more so in ESRD patients. Specifically, in these patients a large part of the CD4+ T cells are continously driven to terminal differentiation yielding highly cytotoxic, proinflammatory T cells. In some patients 40-60 % of their total circulating T cells are terminally differentiated. These CD4+ T cells can be easily recognized by the lack of the CD28 molecule on their cell surface. Such a profound change of the immune system is likely to be reflected in biological processus, like erythropoiesis, that are known to be influenced by pro-inflammatory factors. From our study it appears that indeed the expansion of pro-inflammatory CD4+CD28- is signicantly related to the epoietin demand in hemodialysis patients. This indentifies a novel variable that determines epo-responsiveness in stable, otherwise non-inflammatory HD patients. Further studies in the field are needed to address the question why this CD4+CD28- T cell expansion is not observed in all patients and whether it can be modulated and/or reversed.

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