Humoral immunity and frequency of peritonitis in chronic peritoneal dialysis patients

Abstract

This study was designed to investigate the humoral immune status and immunological abnormalities in relation to the pathogenesis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The levels of serum and dialysate total protein, immunoglobulins (IgG, IgA, IgM, and IgG subgroups), and C3 were measured at baseline and at the end of the study in 12 children and 10 adult patients on CAPD. The relationship between the levels of immunoglobulin and C3 and the frequency of peritonitis was investigated. Peritonitis occurred at a frequency of one episode every 3.9 and 6.3 patient-months in children at the beginning and at the end of the study, respectively; however, the respective rates for adult patients were one episode every 5.6 and 9.8 patient-months. The levels of serum immunoglobulin and C3 were normal in adults at the beginning and at the end of the study. However, the levels of serum IgG were low in 4 of 12 pediatric patients. Of the 4 patients with low total IgG, IgA was low in 1 and IgM was low in 2 patients. Of 4 patients with low total IgG, 2 also had low IgG1 and IgG2. However, 3 of the patients with normal IgG had low IgG2 levels at the end of the study. The levels of C3 were low in 6 of 12 and in 3 of 10 pediatric patients at the beginning and at the end of the study, respectively. The protein levels of dialysate were increased at 1-year follow-up in both groups, but the difference was only statistically significant in adult patients (P<0.05). No correlation was found between the levels of serum and dialysate immunoglobulin and the frequency of peritonitis in either group. In this study, hypogammaglobulinemia and hypocomplementemia were determined in pediatric patients undergoing CAPD. Although these immunological deficits are not major factors in the occurrence of CAPD-related peritonitis, they may contribute to the frequency of peritonitis.

Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

“…Finally, positive correlations have been found between low serum IgG levels and the peritonitis rate, malnutrition, and duration of PD in pediatric CAPD patients (260). However, other studies have reported no relationship between dialysate IgG concentration and peritonitis incidence (253,254,261).…”

“…A disturbance in the release of lymphokines and monokines in some PD patients may also reduce the ability of peritoneal macrophages to kill bacteria (249). Hypogammaglobulinemia, hypocomplementemia, and a decreased chemotactic response of peripheral blood neutrophils have been detected in pediatric patients undergoing CAPD (253)(254)(255). Given those defects, it may be possible to lower the frequency of peritonitis in some patients by providing supplemental IgG.…”

WAVE1 mediates suppression of phagocytosis by phospholipid-derived DAMPs

“…The importance of antibodies and complement in facilitating phagocytosis is well established (17) and explains that IgG-depleted PDF ( Figure 6, B and E) or PLF from antibody-deficient Ldlr/Rag-DKO ( Figure 6C) mice unleashed the pronounced effect of OxPL on phagocytosis. In line with this, higher incidences of bacterial peritonitis were reported in children on peritoneal dialysis with reduced antibody levels (58).…”

Benefits of Low Dose Immunoglobulin in the Treatment of Refractory CAPD Peritonitis and Longevity of Technical Survival on CAPD

“…The second clinical study was reported by Keane et al [19] who employed 250 mg daily doses of IgG, a significant reduction in peritonitis was observed in individuals with low prestudy dialysate IgG. However there are studies which reported no relationship between dialysate IgG concentrations and peritonitis incidence [20][21][22][23]. Two prospective studies attempting to predict the risk of peritonitis in patients new to CAPD failed to show any such association [24,25].…”