Peritoneal Eosinophils during Intermittent Peritoneal Dialysis

Abstract

Peritoneal eosinophil counts were investigated in 61 intermittent dialysis patients over the course of 1 year. The peritoneal eosinophil percentage fell from 18 ± 2% (mean ± SEM) in the first 2 months of dialysis to 3 ± 0.4% after 6 months of dialysis. Absolute eosinophils per cubic millimeter fell from 586 ± 126 to 61 ± 18 (p < 0.01 for both percentage and absolute values). There was a wide range in the mean eosinophil percentages per patient in the first 6 months of dialysis (0–84%) that narrowed to 0–9% after 6 months. The majority of the high initial eosinophil counts resolved after 2 months. Peripheral eosinophilia was seen in 8 of the 10 patients with the highest mean peritoneal eosinophil percentages during the first 2 months of dialysis. Patients who developed peritonitis had a significantly lower percentage of eosinophils in the first 1.5 months of dialysis than patients who did not develop peritonitis. At the time of diagnosis of peritonitis, the peritoneal eosinophil count was near zero. 4 cases of peritoneal eosinophilia which developed after antibiotic therapy are described.

Pathophysiology of Peritoneal Fluid Eosinophilia in Peritoneal Dialysis Patients

“…The absolute number of eosinophils per cubic millimeter fell from 586 ± 126 to 61 ± 18. The majority of the high initial eosinophil counts resolved after 2 months [7]. These observations are in accordance with the known function of eosinophils.…”

“…The incidence of peritoneal fluid eosinophilia is highly variable, ranging from 16 to 60% [4, 5, 7]. The majority of the patients develop peritoneal fluid eosinophila within the first 3 months of the initiation of dialysis, but this phenomenon has been reported as early as 1 day and as late as 6 months after dialysis.…”

“…The differential cell count is characteristic in that there are <60% polymorphonuclear neutrophils and >10% eosinophils. Cultures for microorganisms do not yield any growth and tests for endotoxins are negative [3, 7, 8]. There is no history to suggest a global hypereosinophilic syndrome, allergic disease, parasitic infestation, polyserositis, immunodeficiency syndrome, tuberculosis, malignancy, or connective tissue disease.…”

“…Since peritoneal fluid eosinophilia occurs after catheter insertion and initiation of peritoneal dialysis [19], it has been suggested to be a hypersensitivity reaction to some constituent of the peritoneal dialysis system [3, 7]. Mechanical trauma during insertion of catheter, hypersensitivity reaction to ethylene oxide and other sterilants used in the preparation of dialysate bags [20, 21], plasticizers, additives, impurities, decomposition products and reaction products, still unidentified compounds released from polyvinyl chloride bags and iodine solution used for continuous ambulatory peritoneal dialysis with possible exposure of the peritoneal membrane to iodine, and mechanical irritant action of large volumes of fluid on the peritoneum have all been implicated in the induction of peritoneal fluid eosinophilia [22].…”

Induction of Peritoneal Fluid Eosinophilia and/or Monocytosis by Intraperitoneal Air Injection

“…Peritoneal fluid eosinophilia in peritoneal dialysis pa tients [1][2][3][4][5][6][7][8] occurs most commonly during the first weeks after surgical implantation of a peritoneal dialysis cathe ter and initiation of peritoneal dialysis [2,3]. The cause is unknown.…”