Intraperitoneal immunoglobulin (IG) treatment in prophylaxis of bacterial peritonitis in CAPD

To evaluate peritoneal immunological defences and to find a possible cure for alterations in the mechanism, we studied the capacity of peritoneal dialysis effluent (PDE) to opsonize bacteria and the phagocytic activity of peritoneal macrophages (PM). Subjects were 40 uremic patients followed for a mean period of 36 months and 40 normal women who underwent laparoscopy (Controls). Opsonic capacity for S.epidermidis of undiluted PDE from CAPD patients with low peritonitis occurrence (LPI) proved similar to that of 10% control serum. It was, however, noticeably inferior when patients were of high peritonitis incidence (HPI). In these cases IgG concentration in PDE was lower than in patients of LPI. A significant correlation was revealed between opsonization capacity for bacteria and IgG concentration values in PDE. We found inverse correlation 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 microorganisms were preopsonized by control serum. Intraperitoneal Immunoglobulin treatment raised PDE opsonization capacity and lowered peritonitis incidence in patients of previously HPI, thus demonstrating the importance of abnormal organization in CAPD peritonitis and the possibility of preventing infections by intraperitoneal Immunoglobulin treatment. These prevention results do not occur with intravenous Immunoglobulin treatment.