Article
No evidence of systemic CMV reactivation in chronic hemodialysis patients: a single centre experience
Systemische CMV-Reaktivierung bei chronischen Hämodialyse-Patienten: monozentrische Beobachtungsstudie
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Authors
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R. Pliquett
- Klinikum St. Georg gGmbH, Fachbereich Nephrologie und Dialysezentrum des KfH, Leipzig, Germany
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C. Klein
- Klinikum St. Georg gGmbH, Klinische Chemie und Labormedizin, Leipzig, Germany
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K. Heipmann
- Klinikum St. Georg gGmbH, Fachbereich Nephrologie und Dialysezentrum des KfH, Leipzig, Germany
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B.R. Ruf
- Klinikum St. Georg gGmbH, Klinik für Infektiologie/Tropenmedizin und Nephrologie, Leipzig, Germany
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T. Grünewald
- Klinikum St. Georg gGmbH, Klinik für Infektiologie/Tropenmedizin und Nephrologie, Leipzig, Germany
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J. Beige
- Klinikum St. Georg gGmbH, Fachbereich Nephrologie und Dialysezentrum des KfH, Leipzig, Germany; Klinikum St. Georg gGmbH, Klinik für Infektiologie/Tropenmedizin und Nephrologie, Leipzig, Germany
| Published: | June 2, 2010 |
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Outline
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Objective: Reactivation of Cytomegalovirus (CMV) may cause opportunistic infections in immunocompromised subjects. Uraemia is a condition associated with deficiencies of humoral and cellular immunity leading to an increased risk for opportunistic infections or reactivation of latent infections. In contrast to other etiologies conferring immunosuppression, the risk for CMV DNAemia in CMV-seropositive patients on chronic hemodialysis (HD) is largely unknown.
Goal: Using highly sensitive quantitative polymerase-chain reaction (qPCR) technique, the prevalence of CMV DNAemia among hemodialysis patients was determined.
Method: In a cross-sectional, single centre study plasma samples were collected from all HD patients having given informed consent CMV serology and CMV qPCR (CMM QS CMV Monitor, Roche, USA, lower limit of detection 10–50 copies/ml) were conducted. Additionally, blood counts, markers of inflammation (plasma C-reactive protein) and albumin were analyzed and compared with virological markers.
Results: 87 out of 173 hemodialysis patients (mean age 64.2±16.3 years) gave informed consent and entered this study. No patient showed symptoms attributable to CMV disease. No CMV DNAemia was found using the qPCR method among these 87 hemodialysis patients.
In 52 patients (mean age 61.8±15.8 years), CMV serology was also available. In these, 77% were seropositive for CMV. Eight CMV-seropositive subjects (20%) had borderline (n=4, 10%) or clearly positive (n=4, 10%) IgM antibodies detectable.
Discussion: In absence of viremia, CMV-IgM antibody detection may rather reveal a polyclonal B cell stimulation than reactivation. 3/4 IgM-positive patients had very high IgG antibody concentrations compared to 53.1% of IgM-negative patients. Relative lymphocyte count tended to be higher in CMV-seropositive patients (17.4% in IgG-negative, IgM-negative vs. 23.3% in IgG-positive, IgM-negative and 25.0% in IgG-positive, IgM-positive patients), but reached no significance. C-reactive protein was not different between CMV-positive or CMV-negative groups.
Conclusions: There was no evidence for CMV DNAemia and therefore, no systemic reactivation in HD patients. Apart from this, evaluation of local reactivation is necessary to clarify these data with respect to host defense in end-stage renal disease patients. Moreover, adequate renal replacement therapy may lower the risk for CMV reactivation.
Conflict of interest:none.
