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Nephrol Dial Transplant (1994) 9: 684-692
© 1994 European Renal Association-European Dialysis and Transplant Association

research-article

Analysis of the peritoneal cellular immune system during CAPD shortly before a clinical peritonitis

M. G. H. Betjes1, C. W. Tuk1, C. E. Visser, D. Zemel2, R. T. Krediet2, L. Arisz2 and R. H. J. Beelen1,

1Department of Cell Biology, Vrije Universiteit Amsterdam, The Netherlands 2Renal Unit, Academic Medical Center Amsterdam, The Netherlands

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Rob H. J. Beelen, Department of Cellular Biology, Medical Faculty, Vrije Universiteit, Van der Boechorstraat 7, 1081 BT Amsterdam, The Netherlands

We analysed the peritoneal cellular immune system 24-48 h before the onset of a clinical peritonitis. Peritoneal cells were obtained from the overnight dialysis effluents 1 or 2 days (day-1 and day-2) preceding the day of peritonitis, the last overnight effluent before the peritonitis effluent (day P), and the first peritonitis effluent. Nine peritonitis episodes of six patients were studied. The number of Fc receptor positive cells, the chemotactic activity, and immunophenotype of the peritoneal cell population at day-2 and day-1 were similar to the postperitonitis control effluent. However, immunophagocytosis and phagocytosis capacity of the peritoneal macrophages was decreased in five of six episodes at day-2 and -1 compared to control peritoneal macrophages. The overnight effluents of day P revealed a moderate influx of neutrophilic granulocytes and an increase of bacterial killing capacity and chemotactic activity. Activation of the peritoneal T cells at day P was shown by the increase in MHC class II positive T cells and an increase in the CD4/CD8 ratio. Bacterial cell cultures of the effluents were positive in three episodes 24-48 h before peritonitis, and of all overnight effluents at day P. These results indicate that malfunctioning of phagocytosis by peritoneal macrophages may contribute to the development of a CAPD peritonitis.

Keywords: peritoneal dialysis; peritonitis; macrophages; phagocytosis; immune system


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