Neutrophil function in patients on continuous ambulatory peritoneal dialysis

Abstract

Frequent and recurrent episodes of peritonitis are a major cause of morbidity in patients on continuous ambulatory peritoneal dialysis (CAPD). One factor contributing to this problem may be an abnormality of neutrophil function in these patients. We have therefore quantified phagocytosis and killing by circulating and peritoneal neutrophils from patients on CAPD with and without peritonitis. Circulating neutrophils from uninfected patients showed reduced phagocytosis of both Staphylococcus epidermidis and Candida guilliermondii because of an opsonic defect in CAPD serum and because of a defect of the neutrophils themselves. In contrast, phagocytosis by circulating and peritoneal neutrophils from patients with peritonitis was normal. Intracellular killing of C. guilliermondii was normal in all groups of neutrophils but killing of S. epidermidis, the organism most commonly isolated in CAPD peritonitis, was reduced. The possible mechanisms for the enhanced neutrophil activity seen in peritonitis, and for the decreased killing of S. epidermidis in contrast to normal killing of C. guilliermondii are discussed. A defect in killing of S. epidermidis may explain why peritonitis caused by this organism can be difficult to erradicate.

Impaired Polymorphonuclear Neutrophil Function in End-Stage Renal Failure and Its Correction by Continuous Ambulatory Peritoneal Dialysis

“…We have previously reported that used peritoneal dial ysis effluent contains factors which affect the function of normal PMN, interfering with their ability to kill ingested S. epidermidis [11] and increasing superoxide anion pro duction in response to fMLP [18]. We postulated that these affects are due to low molecular weight uraemic tox ins transferred across the peritoneal membrane from the circulation into the dialysis fluid.…”

“…The method also distin guishes engulfed organisms from those adherent to the surface of the phagocyte. Uraemic serum may not be a satisfactory source of opsonins [11][12][13][14]; this can be con trolled, however, by using pooled normal human serum to opsonize the bacteria. Staphylococcus epidermidis was chosen as the test organism, as this is a common cause of infection in the peritoneum in patients with ESRF.…”

Expansion of CD14+CD16+ Blood Monocytes in Patients with Chronic Renal Failure Undergoing Dialysis: Possible Involvement of Macrophage Colony-Stimulating Factor

“…Patients undergoing long-term dialysis for end-stage renal disease exhibit an immunodeficiency state, including increased susceptibility to infections from various pathogens, probably due to the impaired cellular functions of neutrophils and monocytes/macrophages [2, 3, 4, 5]. Uremia itself causes impairment of cell-mediated immunity, whereas contact of the blood components with the dialysis membrane triggers monocyte activation, leading to the release of pro-inflammatory cytokines such as IL-1β, tumor necrosis factor (TNF)-α and IL-6 [6].…”

“…Patients undergoing long-term hemodialysis (HD) exhibit an immunodeficiency state manifested by increased susceptibility to infections from various pathogens, a high incidence of malignant tumors, anergy in cutaneous-delayed hypersensitivity tests and defective response to T-cell-dependent antigens [2]. The cellular functions of neutrophils and monocytes are impaired in CRF patients on HD or continuous ambulatory peritoneal dialysis (CAPD) [3, 4, 5]. Uremia itself causes an impairment of cell-mediated immunity, whereas the contact of blood components with the dialysis membrane induces monocyte activation, leading to the increased generation of pro- inflammatory cytokines [6].…”

Sürekli Ayaktan Periton Diyaliz Hastalarında Peritonit ve Serum-Diyalizat İmmünglobulin-G Subgrup Düzeyleri İlişkisi

“…(2). Opsonizasyonda çok önemli olan IgG ve C3 düzeyleri SAPD hastalarının periton sıvısında normal periton sıvısındakinin çok altındaki değerlere düşmektedir (3). İntraperitoneal IgG uygulaması ile opsonizasyonun arttığı (4), peritonit sıklığının azaldığı (5) ve refrakter peritonitlerin tedavisinde etkili olduğu (6) saptanmıştır.…”