Specific characteristics of peritoneal leucocyte populations during sterile peritonitis associated with icodextrin CAPD fluids.

BACKGROUND Icodextrin dialysate used for peritoneal dialysis contains an iso-molar glucose polymer solution, which provides sustained ultrafiltration over long dwell times and is considered a valuable approach to reduce intraperitoneal glucose exposure. However, several side effects have been described, including abdominal pain and allergic and hypersensitivity reactions. Also, reactions compatible with chemical peritonitis have been reported. Over the period of a few months (January 2002-May 2002), a remarkable increase in the number of continuous ambulatory peritoneal dialysis (CAPD) patients using icodextrin dialysate diagnosed with sterile peritonitis was observed in our unit. METHODS Five of the CAPD patients using icodextrin dialysate in our unit and diagnosed with sterile peritonitis were screened for leucocyte count and leucocyte differentiation during a follow-up period of 77 +/- 23 days. In addition, expression of CD14, a receptor for lipopolysaccharide (LPS), on the peripheral and peritoneal monocyte population was analysed. These results were compared to CAPD patients suffering from bacterial peritonitis. RESULTS The peritoneal leucocyte count of CAPD patients using icodextrin dialysate and diagnosed with sterile peritonitis did not decrease significantly before treatment with icodextrin dialysate was interrupted, whereas it currently disappeared within 2-4 days in proven bacterial peritonitis. The sterile, cloudy icodextrin effluent contained an excess of macrophages on the day of diagnosis, whereas in bacterial peritonitis essentially an increase in the granulocyte population was observed. No elevation in the eosinophil population was observed. In contrast to bacterial peritonitis, we observed no increase in CD14 expression on the peripheral and peritoneal macrophages on the day of presentation and during the follow-up period. CONCLUSIONS Specific batches of the icodextrin CAPD fluids contain a macrophage chemotactic agent, which causes a sustained inflammatory state in the peritoneal cavity. Because no increase in the expression of the LPS receptor CD14 could be observed, the increased peritoneal leucocyte count is probably not caused by LPS or LPS-like (possibly peptidoglycan-like) contamination.

[1]  O. Skjønsberg,et al.  CD14 Expression and Binding of Lipopolysaccharide to Alveolar Macrophages and Monocytes , 1998, Inflammation.

[2]  É. Goffin,et al.  Transient Sterile Chemical Peritonitis in a CAPD Patient Using Icodextrin , 2002, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[3]  S. Foster,et al.  Peptidoglycan primes for LPS-induced release of proinflammatory cytokines in whole human blood. , 2001, Shock.

[4]  W. Reichel,et al.  A Case of Sterile Peritonitis Associated with Icodextrin Solution , 2001, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[5]  S. Foster,et al.  Peptidoglycan and Lipoteichoic Acid Modify Monocyte Phenotype in Human Whole Blood , 2001, Clinical Diagnostic Laboratory Immunology.

[6]  G. D'Amico,et al.  Recurrent Sterile Peritonitis at Onset of Treatment with Icodextrin Solution , 1999, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[7]  R. Gokal,et al.  Icodextrin provides long dwell peritoneal dialysis and maintenance of intraperitoneal volume. , 1998, Artificial organs.

[8]  R. Krediet,et al.  Icodextrin'S Effects on Peritoneal Transport , 1997, Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis.

[9]  T. Kirkland,et al.  CD14 Is a Cell-activating Receptor for Bacterial Peptidoglycan* , 1996, The Journal of Biological Chemistry.

[10]  N. Schouten,et al.  Peritoneal transport characteristics with glucose polymer based dialysate. , 1996, Kidney international.

[11]  M. Goldman,et al.  Lipopolysaccharide induces up‐regulation of CD14 molecule on monocytes in human whole blood , 1992, European journal of immunology.

[12]  R. Ulevitch,et al.  CD14, a receptor for complexes of lipopolysaccharide (LPS) and LPS binding protein. , 1990, Science.