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Local Immunometabolic Intervention With Alanyl-Glutamine Resolves Peritoneal Dialysis-Induced Immune Cell Dysfunction
Rebecca Herzog1,2, Lisa Daniel-Fischer1,2, Fabian Eibensteiner1,2,3
1Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Kidney International Reports
|April 20, 2026
Summary
Peritoneal dialysis (PD) patients with high inflammation face increased infection risk. Supplementing PD fluid with alanyl-glutamine (AlaGln) improved immune function in these patients, potentially preventing infections.
Area of Science:
- Nephrology
- Immunology
- Metabolism
Background:
- Peritoneal dialysis (PD) is a common home dialysis therapy.
- High-glucose PD fluids can cause inflammation and infection, limiting treatment effectiveness.
Purpose of the Study:
- To investigate the interplay between peritoneal cell immune function, inflammation, and glucose metabolism in PD patients.
- To identify potential therapeutic targets for improving PD outcomes.
Main Methods:
- Prospective cohort study of 117 PD patients with longitudinal follow-up.
- Assessed peritoneal inflammation (IL-6) and immune cell function (cytokine release).
- Performed proteomic and metabolomic profiling of peritoneal effluents; conducted ex vivo experiments.
Main Results:
- Peritoneal inflammation correlated with impaired immune function and increased peritonitis risk (HR: 3.8).
- Patients with high inflammation showed altered glucose and amino acid metabolism.
- Alanyl-glutamine (AlaGln) supplementation restored immune function in inflamed patients.
Conclusions:
- First longitudinal evidence linking PD immunometabolism to inflammation, impaired immunity, and infection.
- Metabolic interventions targeting immune function offer a novel approach to improve PD patient outcomes.
