Automated Peritoneal Dialysis Symposium: Host Defenses in APD

Abstract

The incidence of peritonitis in peritoneal dialysis (PD) has further decreased after the introduction of automated peritoneal dialysis (APD) into clinical routine. Technical advances such as a reduction in the number of connections, more motivated patients, and improved host defense mechanisms in APD have been described. We found that the long daytime interval without dialysate exchanges leads to a higher absolute number of peritoneal macrophages which are capable of an improved first-line host defense. This is demonstrated by a higher release of cytokines of peritoneal macrophages after stimulation with lipopolysaccharides. The dry "day" in nightly intermittent PD seems to have no relevant additional positive effects on peritoneal host defense compared to continuous cyclic peritoneal dialysis. The regeneration of peritoneal cell populations induced by intervals without PD remains relevant even in times when more "biocompatible" PD solutions become available.

Controversies in the Management of Infective Complications of Peritoneal Dialysis

“…As yet there is no evidence to direct clinicians as to whether longer or shorter courses might be beneficial for some causative organisms and whether serial microscopy and culture of dialysate would be necessary for such a strategy. Although seemingly counter-intuitive, longer courses might impair host defences and increase the risk of a subsequent episode of fungal PDP [26]. …”