RT Journal Article
T1 An immuno-fragile profile is associated with mortality risk in patients with chronic kidney disease
A1 Ceprián, Noemí
A1 Martínez De Toda Cabeza, Irene
A1 Jara Caro, Paula
A1 Yuste, Claudia
A1 Valera Arévalo, Gemma
A1 González de Pablos, Ignacio
A1 Figuer, Andrea
A1 Alique, Matilde
A1 Ramírez, Rafael
A1 Morales Ruiz, Enrique
A1 Carracedo, Julia
AB Background/Objectives: Patients with chronic kidney disease (CKD) face higher risks  of infections, poor vaccine responses, and cardiovascular diseases, leading to increased morbidity and mortality due to immune dysfunction and frailty. This study aims to evaluate immune status and frailty in CKD patients across different treatments, examine the influence of frailty on immune status, and link these factors to mortality. Methods: A total of 174 participants were included (end-stage renal disease, ESRD n = 40; hemodialysis, HD n = 40; peritoneal dialysis, n = 36; kidney transplant patients, n = 40; healthy subjects n = 18). Immunophenotyping of lymphocyte and monocyte subpopulations was performed, and frailty was assessed using the Edmonton Frail Scale. Principal component analysis(PCA) integrated immune and frailty variables to define an “immuno-fragile profile,” and survival was monitored for up to six years. Results: CKD patients, especially those on HD, showed decreased lymphocyte counts and proinflammatory monocyte subpopulations with increased expression of costimulatory molecules  B7.2/CD86 and ICAM-1/CD54). Frailty was most prevalent in HD patients (53%), with notable sex differences. PCA identified three components—lymphocyte counts, monocyte co-stimulatory expression, and frailty—that together explained 70% of the variance. Survival analysis revealed that patients with lower lymphocyte counts and higher frailty scores had increased mortality risk, especially in the HD and ESRD groups. Cox regression confirmed that the immuno-fragile profile independently predictedmortality. Conclusions: The integration of immune alterations and frailty defines an immuno-fragile profile strongly associated with mortality in CKD patients, which may serve as a robust prognostic tool to improve risk stratification and guide personalized interventions in clinical practice.
PB MDPI
YR 2025
FD 2025-09
LK https://hdl.handle.net/20.500.14352/125794
UL https://hdl.handle.net/20.500.14352/125794
LA eng
NO Ceprián, N.; Martínez de Toda, I.; Caro, P.J.; Yuste, C.; Valera-Arévalo, G.; González de Pablos, I.; Figuer, A.; Alique, M.; Ramírez, R.; Morales, E.; et al. An Immuno-Fragile Profile Is Associated with Mortality Risk in Patients with Chronic Kidney Disease. Biomedicines 2025, 13, 2370. https://doi.org/ 10.3390/biomedicines13102370
NO FundingThis research was funded by the Instituto de Salud Carlos III through the projects PI17/01029, PI19/00240, PI20/01321, and PI23/01109 (co-funded by the European Regional Development Fund, A Way to Make Europe). NC was a fellow in the “Contratos Asociados a Proyectos de Investigación” program by the Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain. AF was a fellow in the “Contratos Predoctorales de Investigación en Salud” program by the Instituto de Salud Carlos III (FI20/00018). was a fellow in the “Programa de ayudas predoctorales de formación en investigación” program by the Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12, I + 12-AY2OO414-1), Madrid, Spain.
NO European Commission
NO Instituto de Salud Carlos III
DS Docta Complutense
RD 19 mar 2026