Hypogammaglobulinemia in uremic infants receiving peritoneal dialysis

Patients with kidney disease who are receiving peritoneal dialysis (PD) usually have normal levels of antibodies, or immunoglobulins, even though immunoglobulins are known to be lost during PD. Immunoglobulin levels had not been measured in children under two years who have kidney disease, or uremia. To determine whether PD affects immunoglobulin levels, 13 infants with end-stage kidney disease who were treated with PD and 8 uremic infants not treated with PD were evaluated. The average age of the young patients was seven to nine months. Infants treated with PD had significantly lower levels of immunoglobulin of the G subtype, or gamma globulin, compared with nondialyzed infants. Levels of immunoglobulin subtype A were very low in three dialyzed infants and one infant who was not on PD. Losses of gamma globulin were measurable in dialysis fluid, but were not proportionally greater than losses from adults. Immunoglobulin G and A levels improved in patients who received kidney transplants or who stopped PD. Significant bacterial infections occurred in three of eight patients with very low levels of immunoglobulin G. In all of the infants immunoglobulin M levels were within the normal range. These results suggest that suppression of gamma globulin synthesis may occur in uremic infants, but further research is needed to establish the mechanism and outcome of this association. Uremic infants treated with PD may need preventive treatment with immunoglobulin replacement therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)