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Hispanic family caregivers of people with dementia experience higher levels of stress compared to non-Hispanic white caregivers. Long-term stress causes depression, caregiver burden, cellular aging, and dysregulation of the immune, nervous, and endocrine systems. The purpose of this study was to determine the validity of the Spanish version of the English Stress-Busting Program (SBP) for Family Caregivers by determining changes in quality-of-life measures and biomarkers. Thirty-six caregivers completed the SBP in the language of their choice (14 Spanish-speaking Hispanics [HS], 8 English-speaking Hispanics [HE], and 14 non-Hispanic English [NHE] speakers). Quality-of-life measures included the Perceived Stress Scale, the Screen for Caregiver Burden, and the Center for Epidemiologic Studies Depression Scale. Assessment of oral health and immunity included salivary flow rate, pH, buffer capacity, total protein, and secretory immunoglobulin A (sIgA). Indicators of stress (salivary cortisol), inflammation (C-reactive protein), and cellular aging (leukocyte telomere length) were assessed. Following completion of the SBP, the Spanish-speaking group had less depression and caregiver burden along with improved oral health and reduced cellular aging. When comparing baseline values to post-intervention, all three groups showed significant improvement in subjective caregiver burden. When the data from all three groups were combined, biomarkers that showed improvement after nine weeks of SBP included the stress hormone cortisol, salivary pH, and leukocyte telomere length. The results indicate that the Spanish SBP reduces caregiver stress as assessed by quality-of-life indicators and biomarkers. The Spanish SBP can help to mitigate health disparities in Hispanic Spanish-speaking caregivers.

Purpose – The purpose of this paper is to describe the perception and psychosocial impact of caregiving for Latino family caregivers of patients with Alzheimer's disease and related dementias and compare them to non-Hispanic (NH) white caregivers. Design/methodology/approach – The paper opted for a survey design using the Screen for Caregiver Burden, Perceived Stress Scale, Short Form 36 Health Survey, Symptom Questionnaire, Center for Epidemiologic Depression, Sense of Coherence, Coping Resources Inventory, and the Personal Resource Questionnaire (PRQ-85). A total of 202 participants with 53 Latino caregivers (majority were Mexican-Americans) and 149 NH white caregivers also completed an in-depth qualitative interview describing their experience as caregivers. Findings – Latino caregivers, as compared to NH white caregivers, have higher subjective and objective caregiver burden and lower general health, social function, and physical function. They also reported higher levels of bodily pain and somatic sy...

Hilda, a nurse with 10 years of experience, is teaching a patient with a healing wellgranulated wound to irrigate it every day with hydrogen peroxide. Cory, a new nurse who is in the patient’s room, is listening to this conversation. She knows that what Hilda is teaching is not correct but is reluctant to say anything. A few hours later, Cory discusses the patient with Hilda and mentions that peroxide treatment is not appropriate for this patient’s wound. Hilda replies, ‘‘This is the way we always do it and I want to make sure that the wound is really clean.’’ Cory, faced with a dilemma, does not know whether she should alienate Hilda or show her the research findings that document the best practices for wound care. Do we want patients to have health care based on the latest and best knowledge or should they be treated with traditional and ritualistic methods? The best clinical practices are based on research. The primary purposes of nursing research are (1) to expand the knowledge base for nursing practice and (2) to improve the quality of patient care (Fig. 1). In addition to improving patient care, nursing research can reduce health care costs. For this to happen, relevant research needs to be incorporated into clinical practice. Research is of little value unless it is used; however, research findings are not being implemented even when there is evidence that integration of these findings would produce more effective patient outcomes and better clinical practice. Patients suffer unfortunate consequences when advances in research are not incorporated into practice. For many years it has been recognized that a gap exists between what is known (based on research) and what is done in clinical practice. At least 30% to 40% of

There are many industrial experiments where the response variable is nonnormal. Traditionally, variance-stabilizing transformations are made on such a response in order to obtain properties needed to use ordinary least squares and analysis of variance. Generalized linear models (GLMs) offer a powerful alternative to data transformation. Specifically, the performance in response estimation and prediction for a GLM is often superior to the model built using data transformations. The confidence interval constructed around the estimate of the mean for each experimental run provides the experimenter with critical information about model quality. In generalized linear models, confidence intervals are based on asymptotic theory. As such, they are regarded as statistically valid only for large samples. Therefore, in order to use confidence intervals to compare models, it is essential to evaluate these asymptotic intervals in terms of coverage for sample sizes typically encountered in designed industrial experimen...

Generalized linear models (GLMs) may be used as an alternative to traditional methods of analyzing the nonnormal response variables that are frequently encountered in industrial experiments. For the several examples of designed experiments with no..

The application of the generalized linear model (GLM) is illustrated. Analogous model-building processes for the GLM and normal theory linear models are highlighted. The GLM is a regression-type model fitted by maximum likelihood, rather than least sq..

Previous studies of changes in immune function in platelet donors have investigated subjects who were undergoing plateletpheresis using older equipment that is no longer in general use. Therefore, the purpose of this study was to determine the effect of long-term platelet donation on lymphocyte numbers and subsets and plasma protein concentrations in platelet donors using newer cell separators. Three groups included in the study were nondonor controls (n = 27), long-term whole blood donors (n = 29), and long-term platelet donors (n = 20). Using a cross-sectional analysis, lymphocyte numbers and subsets were determined and compared among the three groups. Plasma concentrations of total protein, globulin, albumin, and IgG were also compared. Among the three groups there were no significant differences in total white blood cell counts, percentage or absolute number of lymphocytes, or percentage or absolute number of lymphocyte subsets. Serum total protein, globulin, albumin, and IgG concentrations of platelet donors were within normal ranges. These data support the current Food and Drug Administration (FDA) and American Association of Blood Banks' standards for the frequency of platelet donation allowed and monitoring required for plateletpheresis donors. Furthermore, these data indicate that the FDA could eliminate the requirement for the warning in informed consents about lymphocyte depletion in platelet donors.

Objective Cellular immune function in peritoneal dialysis patients has been shown to be depressed, but the mechanism of this immunosuppression has not been ascertained. Because calcium is an important mediator of lymphocyte activation, this study was designed to investigate if there was an alteration of calcium metabolism in the lymphocytes of continuous ambulatory peritoneal dialysis (CAPD) patients. Design Sixteen CAPD patients were studied at the initiation of CAPD and after two months of treatment. Twenty-three normal controls were also enrolled in the study. Cytoplasmic calcium changes were investigated in response to the mitogen phytohemagglutinin (PHA) in peripheral blood and peritoneal lymphocytes, using the intracellular calcium probe indo-1 and flow cytometry. Baseline cytoplasmic calcium levels and changes in cytoplasmic calcium in response to PHA were assessed at the initiation of CAPD and after two months of therapy. Results Peripheral lymphocytes of patients and controls had similar calcium baseline levels, but the peritoneal lymphocytes had baseline cytoplasmic calcium levels averaging 81% higher than the corresponding calcium levels of the patients’ peripheral blood lymphocytes. As compared to peripheral lymphocytes, the response to PHA stimulation was significantly less in the peritoneal lymphocytes, increasing an average of only 46.8% above baseline. Peripheral blood lymphocytes of the patients responded by an average increase of 78.9% over baseline. Control cells increased an average of 66.3% over baseline. Follow-up studies done two months after the initiation of CAPD indicated there were no significant changes (as compared to month 0) that occurred in baseline or stimulated intracellular calcium concentrations. Conclusions While the peripheral lymphocytes of CAPD patients respond adequately to PHA, the high baseline calcium levels of the peritoneal lymphocytes suggest that these cells may be in a state of chronic activation and may respond minimally to an antigenic challenge.

SUMMARY. The immunomodulating effects of repeated exposure to blood from multiple donors coupled with an immature immune system may predispose the preterm neonate to an increased incidence of infection in his first few months of life. To test this hypothesis, we compared lymphocyte phenotypes, serum IgG concentrations, and histories of infection and rehospitalization in neonates at 4 months corrected age. Two of the study groups were preterm infants who had been transfused with either frozen, deglycerolized or CMV-negative, γ-irradiated blood. Control groups consisted of nontransfused term and preterm infants. There were no differences found in lymphocyte phenotypes or serum IgG concentrations of controls or transfused infants. No differences were found in the infection or rehospitalization incidence in the transfused infants as compared with nontransfused preterm neonates. We failed to show differences in immune parameters or in infection and rehospitalization rates of the preterm infants analysed. Alongside previously published reports, our data suggest that red cell transfusions have a minimal impact on the immature immune system of the neonate.

The role of peritoneal lymphocytes in host immunity for continuous ambulatory peritoneal dialysis (CAPD) patients Is just beginning to be understood. CAPD therapy Increases the proportion of peritoneal lymphocytes, most of which demonstrate signs of activation. There are decreased peritoneal T cells and increased peritoneal B cells as compared to the patients’ peripheral blood. When studies examine Immunophenotypes of peripheral and peritoneallymphocytes over time, no significant changes are found. Although changes in peritoneal lymphocyte subsets occur during peritonitis episodes, there are no changes In peripheral blood lymphocytes. The purpose of this article Is to provide a brief review of research that has studied lymphocytes In CAPD patients.

Few studies addressing possible immune sequelae of long-term whole blood donation have been published. The purpose of this study was to determine if there were any differences in lymphocyte subsets, monocyte and neutrophil receptors, and antigens important to host defense in committed whole blood donors and in nondonor controls. Blood samples were obtained from 27 whole blood donors who had been donating on a regular basis for at least 4 years and from 21 nondonor controls. A panel of single- and dual-labeled monoclonal antibodies was used to characterize peripheral white cells, and then the cells were analyzed by flow cytometry. Lymphocyte subsets included T (CD3) cells, helper T (CD4) cells, suppressor T (CD8) cells, B (CD19) cells, natural killer (NK) (CD56) cells, and subpopulations of T cells defined by the coexpression of markers for CD3/HLA-DR, CD3/CD56, and CD8/CD11b. Monocyte and neutrophil analysis included quantitation of receptors for C5a, formyl-met-leu-phe, and C3bi (CR3). Monocytes were also analyzed for expression of HLA-DR and CD14 antigens. No significant differences were observed in the whole blood donors and nondonor controls for any of these factors used to assess immunologic status, except for an increase in C3bi receptors on both neutrophils and monocytes from whole blood donors. These findings indicate that the lymphocyte parameters analyzed in this study are unaltered by long-term whole blood donation. Further research is necessary to determine the significance of complement receptor upregulation in whole blood donors and to identify any changes in the functional characteristics of peripheral white cells from whole blood donors.

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.

The purpose of this study was to determine if there were differences in selected dialysate white blood cells (WBC) parameters between continuous ambulatory peritoneal dialysis (CAPD) patient groups identified as having a high or low incidence of peritonitis. Parameters studied were total peritoneal WBC yield, percentage and absolute number of various WBC types, and expression of WBC receptors known to be involved in normal host defense mechanisms. WBCs were obtained from peritoneal dialysis effluents (overnight dwell), which were collected at monthly intervals for 6 to 8 months from eight CAPD patients-four with a history of high peritonitis incidence (HPI) (more than two episodes in 12 months) and four with a history of low peritonitis incidence (LPI) (no episodes in more than 24 months). Our results demonstrated that there was no significant difference in the overall mean total cell yields or absolute cell counts between the two patient groups. WBC differentials, although differing somewhat among patients, stayed quite stable over time for an individual patient and there was no significant difference between the two patient groups. Analysis of receptors on the peritoneal WBC was performed using flow cytometry and fluorescein-conjugated chemotactic factors (C5a and Met-Leu-Phe-Lys), as well as monoclonal antibodies specific for Fc receptors and complement receptors, CR1(CD35) and CR3 (CD11 b). Although there was a trend toward increased expression of all of these receptors in the HPI patients, there was no significant difference in the fluorescence intensity of peritoneal neutrophils or macrophages that expressed these receptors between the two patient groups. It has been proposed that altered peritoneal host defense mechanisms exist in patients with a high rate of peritonitis. However, based on the parameters analyzed in this study, no significant differences could be found among patients or between groups identified as having a high or low incidence of peritonitis.

The purpose of the study was to identify factors that influenced family caregivers' decisions to participate in an intervention research study. In interviews conducted before and after the intervention, caregivers (n=21) described reasons for participation. A focused content analysis was used to examine responses. Themes that emerged included: (a) caregivers recognized a need for help; (b) expectations and motivations toward change; (c) recognition of self worth as caregivers; (d) timeliness of recruitment strategies; (e) support of research staff affected recruitment; and (f) caregivers recognized the benefits of participation. These findings support the importance of many different strategies for effective recruitment of caregivers in future studies.

The purpose of this study was to compare emotional and biological responses of men and women who are spousal caregivers of patients with Alzheimer’s disease (AD). Quality-of-life measurements, bioinstrumentation data, and immunophenotype assessments were obtained from female and male spousal caregivers of patients with AD. Spousal caregivers (women, n = 45 with average age 69.7; men, n = 16 with average age 71.4 years) completed questionnaires that assessed psychosocial variables. Blood was drawn and lymphocyte subsets (including natural killer [NK] cell number) were determined using flow cytometry. The degree of relaxation was determined measuring muscle tension (EMG) in the frontalis and trapezius muscles, skin conductance, skin temperature, and heart rate. Male spousal caregivers, as compared to female spousal caregivers, had significantly lower levels of stress, depression, caregiver burden (subjective), anxiety, anger-hostility, and somatic symptoms and higher levels of mental health, sense of coherence, NK cell number, and social and physical functioning. There were no statistically significant differences between the 2 groups in social support, coping resources, or T, T suppressor, or activated T cells. Women had more T helper cells and fewer NK cells than men. Men had fewer manifestations of a physiological stress response, as indicated by bioinstrumentation parameters. Unique sex-specific issues need to be considered when strategies are implemented to assist the increasing number of caregivers as our society ages.

A 45-year-old woman who was treated with continuous ambulatory peritoneal dialysis (CAPD) developed recurrent peritonitis characterized by cloudy effluents, elevated white blood cell (WBC) counts (predominantly lymphocytes), and negative culture results. This case report suggests that she may have had viral peritonitis as indicated by a positive viral culture, the presence of viral antibodies in serum and peritoneal dialysis effluent (PDE), hematological findings, and cell surface receptor studies. The possibility of a viral cause should be considered in patients with culture-negative peritonitis, especially if they do not respond to antibiotics.

BACKGROUND: The possible effects of long-term plasma donation remain unknown, but it is important to investigate them so that donor safety is ensured. The purpose of this study was to determine if long-term plasma donation alters plasma proteins or lymphocyte phenotypes. STUDY DESIGN AND METHODS: Two groups of long-term plasma donors, source plasma donors (n = 20) and Rh immune globulin plasma donors (n = 26), were compared with whole blood donors (n = 29) and nondonor controls (n = 30). Blood samples were obtained prior to donation. Serum protein, albumin, globulin, and immunoglobulin levels were determined. In an assay using whole blood, lymphocyte phenotypes were characterized with a panel of single- and dual-labeled monoclonal antibodies and subsequent analysis by flow cytometry. RESULTS: As compared to the nondonor controls and/or whole blood donors, the mean values for serum protein, globulin, and IgG levels were lower in both plasma donor groups, with a significant negative correlation between donation frequency and serum protein values for the source plasma donors. Albumin levels were within normal ranges for both groups of plasma donors. No significant differences existed among the donor groups in total white cell counts, the percentage or absolute number of lymphocytes, T (CD3) cells, or helper T (CD4) cells. However, there were increased percentages of B (CD19) cells and decreased percentages of suppressor T (CD8+/CD11b+) cells and natural killer cells in both groups of plasma donors as compared to nondonor controls. CONCLUSION: Many plasma donors have low levels of serum protein, globulin, and IgG. In addition, they have increased percentages of B cells and decreased percentages of suppressor T and natural killer cells. The clinical significance of these findings warrants further investigation.

It is general experience that some patients receiving long-term peritoneal dialysis suffer from repeated episodes of peritonitis while others remain relatively free of this complication. It has been suggested that differences in the ability of individual subjects to resist infection, i.e., their host defence, are at least partly responsible for this clinical observation. This hypothesis was strengthened by the report by Verbrugh et al. on the potential efficacy of peritoneal macrophages and opsonins in the antibacterial defence of such patients [1]. In this chapter we review the available evidence on the various components of host defences of peritoneal dialysis patients including the effect of the dialysate.

A 60-year-old Native American diabetic female patient had a history of nine episodes of peritonitis (both relapsing and persistent) during the year that she was treated with continuous ambulatory peritoneal dialysis (CAPD). At the start of CAPD the patient had an inverted CD4 to CD8 ratio that decreased from 0.97 to 0.50 in 1 year. This finding was due to a decrease in CD4 + cells and an increase in CD8 + cells that were also positive for CD57 (Leu-7) and HLADR (la) antigen, suggesting a state of activation. The serology indicated a cytomegalovirus immunoglobulin G titer of 1:2,048. The patient also had significantly increased natural killer cells. These alterations suggest the presence of a chronic viral infection that may have caused the patient to be immunosuppressed, thereby predisposing her to repeated episodes of peritonitis.

C5a is generated by the activation of the complement system with the cleavage of complement component C5 into C5a and C5b. C5a, an important in vivo chemotactic factor and anaphylatoxin, was first identified as having an important role in dialysis patients by Craddock et al (1,2,3) in the 1970’s. Previously various investigators had observed that leukopenia occurred during the first 30 minutes of hemodialysis (HD) with cellulose dialysis membranes (4,5,6,7). Craddock et al demonstrated that this leukopenia resulted from pulmonary sequestration of neutrophils (PMN) which was provoked by a complement component generated from contact of the patient’s blood with the cellophane dialyzer (1,2,3). C5a became the likely suspect because it was known to induce neutrophil aggregation in vivo and it was logically reasoned that PMN and monocytes would accumulate in the lungs, the first large capillary network encountered in circulation, following passage of blood through the dialyzer.

(1999). Applying Generalized Linear Models. Journal of Quality Technology: Vol. 31, No. 3, pp. 353-354.

Casein is chemotactic for human neutrophils (PMNs) and monocytes. The binding of fluorescein (FITC)-conjugated casein (mixture of alpha, beta, and kappa-casein) and purified alpha-casein to PMNs, monocytes, and lymphocytes was analyzed using flow cytometry. These studies demonstrate that 75-95% of PMNs and 46-85% of monocytes have membrane receptors for casein while lymphocytes lack these receptors. The binding of FITC-casein and FITC-alpha-casein was specific and was blocked only by unlabeled casein and alpha-casein, but not by ovalbumin, bovine or human serum albumin, beta-casomorphin, C5a, or formyl-methionyl-leucylphenylalanine (fMLP). The binding of FITC-casein was reversible when PMNs were stained with this fluorescent agent and subsequently incubated with unlabeled casein. Double-labeling studies of mononuclear cells using FITC-casein and the OKM1 monoclonal antibody in conjunction with a rhodamine conjugated anti-Ig second antibody demonstrate that mononuclear cells binding FITC-casein also stain with the OKM1 monoclonal antibody, indicating a specificity for monocytes.

Leukocyte C5a receptor modulation during hemodialysis. Exposure of blood to hemodialysis (HD) membranes results in the activation of the complement system. In this study, flow cytometry was used to analyze the binding of fluoresceinated chemotactic factors (C5a, f-Met-Leu-Phe-Lys [fMLPL], and casein) and aggregated IgG to PMN and monocytes isolated from normal whole blood following passage through a hemodialyzer. Analysis of ligand binding by these PMN and monocytes showed no difference in the binding of casein, fMLPL, or aggregated IgG throughout the 45 minute procedure. In contrast, a progressive decrease in the binding of C5a by PMN and monocytes occurred. By 45 minutes, the average percentage of PMN binding C5a had dropped from 95 to 61% and monocytes from 73 to 40%. In additional studies, blood samples were obtained from chronic renal failure patients undergoing hemodialysis at four different time intervals during dialysis. Total white blood cell (WBC) counts showed that the mean WBC count at 30 minutes dropped to 60.9% of the predialysis WBC count, and rebounded to 133.8% by two hours and 128.2% by four hours. Analysis of the binding of C5a, casein, fMLPL, or aggregated IgG by PMN or monocytes from HD patients indicated there were no significant differences at the four time intervals studied. When blood samples from normal subjects or chronic hemodialysis patients were incubated in vitro with dialysis membrane fibers, a loss of identifiable C5a receptors was observed on PMN from normal blood, while PMN from HD patients showed no significant change in the percentage of C5a-receptor-positive cells. When normal PMN were isolated and resuspended in either normal or patient plasma and then exposed to HD membrane fibers, only cells in normal plasma showed a significant drop in C5a binding. These studies indicate that C5a receptors on PMN and monocytes obtained from normal donor blood exposed to dialysis membranes are specifically blocked or internalized. In contrast, even though PMN and monocytes from HD patients are continuously exposed to C5a generated during the dialysis procedure, they do not show a decrease in the binding of C5a. These findings suggest that adaptive mechanisms function in chronically hemodialyzed patients to modulate the effects of excessive C5a generation during HD.

Analysis of standard Ficoll-Hypaque (density = 1.077 g/ml) separation profiles of peripheral white blood cells (WBC) from patients undergoing hemodialysis (HD) demonstrated that dialysis caused a marked decrease in the density of polymorphonuclear leukocytes (PMN) resulting in about 50% of these cells separating with the mononuclear cells. In vitro exposure of normal control peripheral blood to HD membranes as well as to the purified chemotactic factors C5a, C5ades-Arg, and formyl-Met-Leu-Phe (fMLP) also resulted in PMN density changes which altered the Ficoll-Hypaque separation profiles of WBC. Therefore, these results imply that C5a generation, resulting from complement activation by the HD membrane, induced the density changes in the PMN from HD patients. Further studies using flow cytometry and fluorescein-labeled chemotactic factors (C5a, formyl-Met-Leu-Phe-Lys [fMLPL] and casein) indicated that HD patients had a significant reduction in the ability of their PMN and monocytes to bind C5a. This contrasted with the findings of no significant difference in the percentage or fluorescence intensity of HD patients' PMN or monocytes binding casein or fMLPL. Functional studies to analyze chemotactic-factor-mediated responses indicated that there was a decreased ability of HD patients' PMN and monocytes to generate superoxide anion, produce H2O2 and release myeloperoxidase in response to both C5a and fMLP. Additional studies evaluated the binding of chemotactic factors to PMN and monocytes from normal blood following passage through a hemodialyzer and from patients undergoing HD. Analysis of receptor binding by control cells passed through the dialyzer showed that there was a progressive decrease in the percentage of C5a-receptor-positive PMN and monocytes but no change with casein or fMLPL. In contrast, peripheral PMN and monocytes from chronic renal failure patients on HD showed no difference in C5a, casein or fMLPL receptors during the course of HD as compared to the predialysis period. This appears to be attributable to a difference in the regulation of the C5a that is generated as a result of the dialysis-membrane-induced activation of the complement system. Although C5a has been shown to be continuously generated during the course of HD, these patients show no modulation of their C5a receptors during the course of HD or when their whole blood is exposed to dialysis membrane fibers. These findings suggest that there are mechanisms functioning in chronically dialyzed patients to protect them from the effects of excessive C5a generation during HD.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of standard Ficoll-Hypaque separation profiles of peripheral WBC from patients undergoing hemodialysis (HD) demonstrated that dialysis caused a marked alteration in the number of cells found at both the interface between the Ficoll-Hypaque and plasma which normally contains mononuclear cells and the cell pellet which normally contains granulocytes. By 30 min into dialysis, there was a 175% increase in white blood cells in the mononuclear band with a corresponding decrease in the number of cells obtained from the cell pellet. When peripheral blood samples from normal donors were pumped through various types of hemodialyzers, a shift in the cell separation profiles similar to that of patients undergoing HD was observed. Differential analysis of the cells obtained from both the interface between the Ficoll-Hypaque and plasma and the cell pellet showed that by 30 min into dialysis, the 'mononuclear' band contained 40-50% polymorphonuclear neutrophils (PMN). To ascertain whether the cell separation changes were possibly due to C5a generation resulting from complement activation by the HD membrane, whole blood was incubated with the purified chemotactic factors C5a, C5ades arg, and formyl-methionyl-leucyl-phenylalanine. This resulted in similar alterations in PMN densities. This study demonstrates that both in vivo and in vitro exposure of human peripheral blood to HD membranes as well as the chemotactic factors C5a, C5ades arg, and formyl-methionyl-leucyl-phenylalanine results in density changes in PMN.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic renal failure patients maintained on dialysis have an increased risk for infection. This article summarizes research that has been done on the function of neutrophils (PMNs) and monocytes from chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. The studies involving the HD patients showed that there is a decreased PMN in vitro chemotactic response, decreased C5a receptors on both PMNs and monocytes, and decreased oxidative metabolic responses of PMNs and monocytes to the chemotactic stimuli C5a and formyl-met-leu-phe (fMLP), but not to nonchemotactic factors. The results of studies involving phagocytosis have been conflicting and are discussed in this paper. Due to the basic principles of peritoneal dialysis, this treatment approach depletes the peritoneum of phagocytic cells, adversely affects the function of peritoneal WBCs, dilutes the existing opsonins, and alters the physiologic environment of the peritoneal cavity. Studies of peripheral PMN and monocyte function in CAPO patients have shown that, similar to HD patients, they also have decreased C5a receptors and decreased oxidative metabolic responses to the chemotactic factors C5a and fMLP. Although the factors contributing to the risk of infection in chronic dialysis patients are multifaceted, there are definitely alterations in PMN and monocyte function.