1,25-Dihydroxycholecalciferol and Peritoneal Macrophage Chemotaxis in Patients on Continuous Ambulatory Peritoneal Dialysis

Chan, Patricia C.K.; Ip, Mary Sau Man; Pun, KwanC .

doi:10.1159/000186604

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…In formation on the relationship of dialysate op- There have been a number of approaches to improve peritoneal immune function and thus decrease peritonitis rates. IgG, a-interferon, and 1,25(OH)2vitamin D added to dial ysate have been used with variable success [25][26][27], However, these approaches are ex pensive and impractical. Another approach, vaccination against Staphylococcus, was found in a multicenter study to have no effica cy in prevention of peritonitis [28], although another vaccine trial is underway.…”

Section: Preventing Peritonitis By Enhancing Host Defensesmentioning

confidence: 99%

Research Directions in Peritoneal Dialysis Infections

Piraino¹

1995

Blood Purif

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There are many promising areas of research on peritoneal dialysis related infections. Improvements in connection technology, especially the Y set and CCPD, have led to a decrease in the rate of peritonitis due to Staphylococcus epidermidis. The search to find a more biocompatible dialysate that is less immunocompromising is underway; clinical trials examining peritonitis rates with these new formulations remain to be performed. Considerable progress has been made in elucidating peritonitis related to catheter infection, especially that due to Staphylococcus aureus. Nasal carriage has been identified as a risk factor for subsequent infections. Several prophylactic antibiotic approaches including rifampin, trimethoprim/sulfa-methoxazole and mupirocin have shown promise in reducing these infections. Innovative catheter designs that decrease the risk of bacterial colonization are another investigative approach. The timing of both catheter removal and replacement for infection is controversial and requires further study. Lastly, much remains to be learned about peritonitis from an enteric source.

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Section: Preventing Peritonitis By Enhancing Host Defensesmentioning

confidence: 99%

Research Directions in Peritoneal Dialysis Infections

Piraino¹

1995

Blood Purif

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Host defences in continuous ambulatory peritoneal dialysis and the genesis of peritonitis

Cameron¹

1995

Pediatr Nephrol

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Continuous ambulatory peritoneal dialysis (CAPD) has come to be extensively used for the treatment of end-stage renal failure in children, and especially infants, such that now more than half of children on dialysis worldwide receive treatment by this means. Peritonitis, however, is commoner in children than in adults receiving treatment, and is a major source of morbidity and treatment failure in children started on CAPD. Only recently has the immunology of the normal peritoneum been studied extensively, with the need to assess the impact of the installation of large volumes of fluid into the peritoneal sac during dialysis. The main phagocytic defences of the peritoneum depend upon a unique set of macrophages which are present free in the peritoneal fluid but also in the submesothelium and in perivascular collections together with B lymphocytes in the submesothelial area. Both the number of macrophages per unit volume and the concentration of opsonic proteins, such as IgG, complement and fibronectin, are reduced to between only 1% and 5% when dialysis fluid is continuously present in the peritoneal sac. In addition, the fluids used for CAPD are toxic to both macrophages and to mesothelial cells. Thus minor degrees of contamination frequently lead to peritonitis and in addition the majority of patients have catheters inserted in their peritoneum which become colonised with organisms capable of producing exopolysaccharide (slime), which promotes adhesion of the organism to the plastic and protects them against phagocytic attack and the penetration of antibiotics. Thus the peritoneum is in a state of continual inflammation, as well as being a markedly more vulnerable site than the normal peritoneum to the entry of organisms. Whether clinical peritonitis appears in this state of chronic contamination probably depends on perturbation in the balance between host defences and the organism. Whilst Staphylococcus epidermidis is the commonest cause of peritonitis, Staphylococcus aureus and Gram-negative organisms are much more serious and more frequently lead either to temporary catheter removal or discontinuation of dialysis altogether. This review describes the peritoneal defences in relation to the genesis of peritonitis.

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1,25-Dihydroxycholecalciferol and Peritoneal Macrophage Chemotaxis in Patients on Continuous Ambulatory Peritoneal Dialysis

Cited by 2 publications

References 9 publications

Research Directions in Peritoneal Dialysis Infections

Research Directions in Peritoneal Dialysis Infections

Host defences in continuous ambulatory peritoneal dialysis and the genesis of peritonitis

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