Peritoneal Defense Mechanisms—the Effects of New Peritoneal Dialysis Solutions

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 198-201 ◽  
Author(s):  
Rumeyza Kazancioglu
Keyword(s):  
Peritoneal Dialysis ◽  
Host Defense ◽  
Defense Mechanisms ◽  
Abdominal Cavity ◽  
Peritoneal Macrophages ◽  
Continuous Exposure ◽  
Lymphatic Uptake ◽  
Smooth Membrane ◽  
Micro Organisms ◽  
Dialysis Solutions

It remains to be determined whether the peritoneal dialysis procedure induces abnormalities in the normal host defenses of the abdominal cavity and whether these perturbations are important in the pathogenesis of peritonitis. The peritoneum is a smooth membrane that lines the abdominal cavity and participates in the diffusion of water and solutes during peritoneal dialysis. The diaphragmatic lymphatic uptake and the opsonization of micro-organisms, with phagocytosis and killing by peritoneal macrophages, mesothelial cells, lymphocytes, polymorphonuclear leukocytes, and newly defined proteins such as defensins, play a combined role in the peritoneal host defense. Because the composition of earlier peritoneal dialysis fluids is clearly non-physiologic, continuous exposure of peritoneal cells to these solutions may result in an impairment of the local peritoneal host defense mechanisms. However, with the newer solutions, it has been shown that peritoneal defense mechanisms may improve.

The Effects of Peritoneal Dialysis Solutions on Peritoneal Host Defense

2004 ◽  
Vol 24 (2) ◽  
pp. 123-138 ◽  
Author(s):  
Siska Mortier ◽  
Norbert H. Lameire ◽  
An S. De Vriese
Keyword(s):  
Peritoneal Dialysis ◽  
Host Defense ◽  
Polymorphonuclear Leukocytes ◽  
Degradation Products ◽  
Peritoneal Macrophages ◽  
Inhibitory Effects ◽  
Bacterial Killing ◽  
Causative Factors ◽  
Peritoneal Dialysis Fluid ◽  
Osmotic Agents

Conventional peritoneal dialysis fluid (PDF) is a bioincompatible solution owing to the acidic pH, the high glucose concentrations and the associated hyperosmolarity, the high lactate concentrations, and the presence of glucose degradation products (GDPs). This unphysiologic composition adversely affects peritoneal host defense and may thus contribute to the development of PD-related peritonitis. The viability of polymorphonuclear leukocytes, monocytes, peritoneal macrophages, and mesothelial cells is severely depressed in the presence of conventional PDF. In addition, the production of inflammatory cytokines and chemoattractants by these cells is markedly affected by conventional PDF. Further, conventional PDF hampers the recruitment of circulating leukocytes in response to an infectious stimulus. Finally, phagocytosis, respiratory burst, and bacterial killing are markedly lower when polymorphonuclear leukocytes, monocytes, and peritoneal macrophages are exposed to conventional PDF. Although there are a few discrepant results, all major PDF components have been implicated as causative factors. Generally, novel PDF with alternative osmotic agents or with alternative buffers, neutral pH, and low GDP content have much milder inhibitory effects on peritoneal host defense. Clinical studies, however, still need to demonstrate their superiority with respect to the incidence of PD-related peritonitis.

Host Defense Mechanisms in the Peritoneal Cavity of Continuous Ambulatory Peritoneal Dialysis Patients: First of Two Parts

1991 ◽  
Vol 11 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Sharon Lewis ◽  
Clifford Holmes
Keyword(s):  
Peritoneal Cavity ◽  
Defense Mechanisms ◽  
White Blood Cells ◽  
Lymphocyte Activation ◽  
Peritoneal Macrophages ◽  
Dialysis Patients ◽  
Clinical Consequences ◽  
Chronic Activation ◽  
Free Media ◽  
Dialysis Solutions

This article provides a review of studies on peritoneal white blood cells (WBC) in CAPD patients. To some extent these studies support the concept that the peritoneal cavity of these patients contains adequate-functioning WBC that can provide effective antimicrobial defenses when they are studied in dialysate-free media. Commercially available dialysis solutions significantly impair WBC function. In some patients with high incidences of peritonitis, there appears to be reduced bactericidal capacity of their peritoneal macrophages. CAPD seems to contribute to a state of both macrophage and lymphocyte activation in the peritoneal cavity. The clinical consequences of this chronic activation are not known.

Defective Opsonic Activity of Peritoneal Effluent during Continuous Ambulatory Peritoneal Dialysis (CAPD): Importance and Prevention

1986 ◽  
Vol 6 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Silvano Lamperi ◽  
Silvia Carozzi
Keyword(s):  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Phagocytic Activity ◽  
Peritoneal Macrophages ◽  
Phagocytic Capacity ◽  
Opsonic Activity ◽  
Control Serum ◽  
Normal Women ◽  
Micro Organisms ◽  
Peritoneal Dialysis Effluent

To evaluate peritoneal immunological defenses and to find a way to prevent peritonitis we have studied the capacity of peritoneal dialysis effluent (PDE) to opsonize bacteria, and the phagocytic activity of peritoneal macrophages (PM). The subjects were 40 uremic patients followed for a mean period of 36 months and 40 normal women who underwent laparoscopy (controls). Opsonic capacity for Staphylococcus epidermidis of undiluted PDE from CAPD patients with low peritonitis incidence (LPI) proved to be similar to that of 10% control serum. However, the capacity of effluent from patients with a high peritonitis incidence (HPI) was noticeably inferior. In these cases, IgG concentration in PDE was lower than in LPI patients. There was a significant correlation between opsonization capacity for bacteria and IgG concentration values in PDE. We found inverse correlations between opsonic capacity of PDE and number of episodes of peritonitis. Phagocytic capacity of PM from CAPD patients was similar to that of control PM when micro-organisms were preopsonized by control serum. Treatment with intraperitoneal intmunoglobulin raised PDE opsonization capacity and lowered the incidence in those with previous HPI, thus demonstrating the importance of abnormal opsonization in CAPD peritonitis and the possibility of preventing infection by prophylaxis with intraperitoneal immunoglobulin. Intravenous immunoglobulin does not reduce the incidence of infection.

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