Sargramostim for Myeloid Dendritic Cell Deficiency

Inclusion Criteria: * Age \>18 years \< 80 years with diagnosis of end stage renal disease and currently undergoing outpatient hemodialysis (HD) at one of the Johns Hopkins University-affiliated HD units Exclusion Criteria: * Age\<18or\>80years * History of non-adherence to prescribed HD treatment * Active drug or heavy alcohol use (defined as \> 4 drinks/day) * Pregnancy or breast feeding * Active infection (bacterial or viral) or clinically significant infections within the past three months (e.g. those requiring hospitalization, or as judged by the PI) * Active malignancy (with the exception of excised non-metastatic basal cell carcinoma or squamous cell carcinoma of the skin, or adequately treated pre- invasive cervical cancer in situ) * Unstable cardiovascular status (angina, arrhythmias, congestive heart failure etc...) * History of liver disease (as defined by a diagnosis of uncompensated cirrhosis) • History of lung disease (including moderate-severe chronic obstructive pulmonary disease, interstitial lung disease, or asthma) * Known hypersensitivity to yeast-derived products * Hemoglobin \< 10 g/dL and hematocrit \< 30%. * Abnormal white blood cell (WBC) count at baseline (\< 3 or \> 12 x 10 cells/mm ) * Treatment with WBC growth factors (G-CSF or GM-CSF) or immunosuppressive medications (tacrolimus, cyclosporine, mycophenolate, azathioprine, corticosteroids, chlorambucil, cyclophosphamide) within 4 weeks of study (erythropoiesis-stimulating agents will be allowed) * Treatment with lithium within 4 weeks of study