The Complement System in Dialysis: A Forgotten Story?

Overview

Journal Front Immunol

Specialty Allergy & Immunology

Date 2018 Feb 10

PMID 29422906

Citations 55

Authors

Felix Poppelaars

Bernardo Faria

Mariana Gaya DA Costa

Casper F M Franssen

Willem J van Son

Stefan P Berger

Mohamed R Daha

Marc A Seelen

Affiliations

Soon will be listed here.

Abstract

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.

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