Hypogammaglobulinemia in infants receiving chronic peritoneal dialysis

Shwetal Lalan, Hongying Dai, Bradley A. Warady

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Peritonitis is a severe complication of chronic peritoneal dialysis (CPD) in infants. Few studies have been conducted to evaluate the relationship between hypogammaglobulinemia and peritonitis risk, and the potential benefit of intravenous immunoglobulins (IVIG) therapy in infants receiving CPD. Methods: Patients aged 0–12 months at initiation of CPD between 1985 and 2012 were eligible for inclusion in this retrospective study. Data collected from the start of CPD up to 2 years post-dialysis initiation included patient demographics, dialysis characteristics, serum immunoglobulin (IgG) levels, IVIG administration history, infectious complications and outcomes. Cox regression analysis and linear mixed model analysis were used for statistical analysis. Results: Twenty-six consecutive patients were included in the study. Annualized peritonitis rates for infants aged 0–30 days (≤1-month age group; n = 16; 320.3 patient-months) and 31–365 days (>1–12-month age group; n = 10; 163.3 patient-months) at dialysis initiation were 0.27 (1 episode per 45.8 patient-months) and 0.15 (one episode per 81.7 patient-months), respectively. Seventy-six percent of the serum IgG levels were >1 standard deviation below the age-appropriate mean levels, and these did not differ in those who developed peritonitis versus those who did not (p = 0.39). Serum IgG levels were significantly lower in patients on CPD with oligoanuria than in non-oliguric patients (p = 0.04) and in patients on CPD for >90 days as compared to those who had received CPD for <90 days (p = 0.018). IVIG therapy was provided to 20 patients with hypogammaglobulinemia; this high prevalence of IVIG usage precluded any drawing of conclusion on the potential role of IVIG in the prevention of peritonitis. Conclusions: Hypogammaglobulinemia is a frequent complication of CPD during infancy. In our experience, it was not associated with an increased risk for peritonitis.

Original languageEnglish (US)
Pages (from-to)503-509
Number of pages7
JournalPediatric Nephrology
Volume32
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Agammaglobulinemia
Peritoneal Dialysis
Peritonitis
Intravenous Immunoglobulins
Dialysis
Passive Immunization
Immunoglobulin G
Age Groups
Serum
Intravenous Administration
Immunoglobulins
Linear Models
Retrospective Studies
History
Regression Analysis
Demography

Keywords

  • Hypogammaglobulinemia
  • Immunoglobulin
  • Infant dialysis
  • Neonates
  • Peritoneal dialysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Cite this

Hypogammaglobulinemia in infants receiving chronic peritoneal dialysis. / Lalan, Shwetal; Dai, Hongying; Warady, Bradley A.

In: Pediatric Nephrology, Vol. 32, No. 3, 01.03.2017, p. 503-509.

Research output: Contribution to journalArticle

Lalan, Shwetal ; Dai, Hongying ; Warady, Bradley A. / Hypogammaglobulinemia in infants receiving chronic peritoneal dialysis. In: Pediatric Nephrology. 2017 ; Vol. 32, No. 3. pp. 503-509.
@article{6cdb64b36b7940e390279884ee3abdca,
title = "Hypogammaglobulinemia in infants receiving chronic peritoneal dialysis",
abstract = "Background: Peritonitis is a severe complication of chronic peritoneal dialysis (CPD) in infants. Few studies have been conducted to evaluate the relationship between hypogammaglobulinemia and peritonitis risk, and the potential benefit of intravenous immunoglobulins (IVIG) therapy in infants receiving CPD. Methods: Patients aged 0–12 months at initiation of CPD between 1985 and 2012 were eligible for inclusion in this retrospective study. Data collected from the start of CPD up to 2 years post-dialysis initiation included patient demographics, dialysis characteristics, serum immunoglobulin (IgG) levels, IVIG administration history, infectious complications and outcomes. Cox regression analysis and linear mixed model analysis were used for statistical analysis. Results: Twenty-six consecutive patients were included in the study. Annualized peritonitis rates for infants aged 0–30 days (≤1-month age group; n = 16; 320.3 patient-months) and 31–365 days (>1–12-month age group; n = 10; 163.3 patient-months) at dialysis initiation were 0.27 (1 episode per 45.8 patient-months) and 0.15 (one episode per 81.7 patient-months), respectively. Seventy-six percent of the serum IgG levels were >1 standard deviation below the age-appropriate mean levels, and these did not differ in those who developed peritonitis versus those who did not (p = 0.39). Serum IgG levels were significantly lower in patients on CPD with oligoanuria than in non-oliguric patients (p = 0.04) and in patients on CPD for >90 days as compared to those who had received CPD for <90 days (p = 0.018). IVIG therapy was provided to 20 patients with hypogammaglobulinemia; this high prevalence of IVIG usage precluded any drawing of conclusion on the potential role of IVIG in the prevention of peritonitis. Conclusions: Hypogammaglobulinemia is a frequent complication of CPD during infancy. In our experience, it was not associated with an increased risk for peritonitis.",
keywords = "Hypogammaglobulinemia, Immunoglobulin, Infant dialysis, Neonates, Peritoneal dialysis",
author = "Shwetal Lalan and Hongying Dai and Warady, {Bradley A.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1007/s00467-016-3487-1",
language = "English (US)",
volume = "32",
pages = "503--509",
journal = "Pediatric Nephrology",
issn = "0931-041X",
publisher = "Springer Verlag",
number = "3",

}

TY - JOUR

T1 - Hypogammaglobulinemia in infants receiving chronic peritoneal dialysis

AU - Lalan, Shwetal

AU - Dai, Hongying

AU - Warady, Bradley A.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: Peritonitis is a severe complication of chronic peritoneal dialysis (CPD) in infants. Few studies have been conducted to evaluate the relationship between hypogammaglobulinemia and peritonitis risk, and the potential benefit of intravenous immunoglobulins (IVIG) therapy in infants receiving CPD. Methods: Patients aged 0–12 months at initiation of CPD between 1985 and 2012 were eligible for inclusion in this retrospective study. Data collected from the start of CPD up to 2 years post-dialysis initiation included patient demographics, dialysis characteristics, serum immunoglobulin (IgG) levels, IVIG administration history, infectious complications and outcomes. Cox regression analysis and linear mixed model analysis were used for statistical analysis. Results: Twenty-six consecutive patients were included in the study. Annualized peritonitis rates for infants aged 0–30 days (≤1-month age group; n = 16; 320.3 patient-months) and 31–365 days (>1–12-month age group; n = 10; 163.3 patient-months) at dialysis initiation were 0.27 (1 episode per 45.8 patient-months) and 0.15 (one episode per 81.7 patient-months), respectively. Seventy-six percent of the serum IgG levels were >1 standard deviation below the age-appropriate mean levels, and these did not differ in those who developed peritonitis versus those who did not (p = 0.39). Serum IgG levels were significantly lower in patients on CPD with oligoanuria than in non-oliguric patients (p = 0.04) and in patients on CPD for >90 days as compared to those who had received CPD for <90 days (p = 0.018). IVIG therapy was provided to 20 patients with hypogammaglobulinemia; this high prevalence of IVIG usage precluded any drawing of conclusion on the potential role of IVIG in the prevention of peritonitis. Conclusions: Hypogammaglobulinemia is a frequent complication of CPD during infancy. In our experience, it was not associated with an increased risk for peritonitis.

AB - Background: Peritonitis is a severe complication of chronic peritoneal dialysis (CPD) in infants. Few studies have been conducted to evaluate the relationship between hypogammaglobulinemia and peritonitis risk, and the potential benefit of intravenous immunoglobulins (IVIG) therapy in infants receiving CPD. Methods: Patients aged 0–12 months at initiation of CPD between 1985 and 2012 were eligible for inclusion in this retrospective study. Data collected from the start of CPD up to 2 years post-dialysis initiation included patient demographics, dialysis characteristics, serum immunoglobulin (IgG) levels, IVIG administration history, infectious complications and outcomes. Cox regression analysis and linear mixed model analysis were used for statistical analysis. Results: Twenty-six consecutive patients were included in the study. Annualized peritonitis rates for infants aged 0–30 days (≤1-month age group; n = 16; 320.3 patient-months) and 31–365 days (>1–12-month age group; n = 10; 163.3 patient-months) at dialysis initiation were 0.27 (1 episode per 45.8 patient-months) and 0.15 (one episode per 81.7 patient-months), respectively. Seventy-six percent of the serum IgG levels were >1 standard deviation below the age-appropriate mean levels, and these did not differ in those who developed peritonitis versus those who did not (p = 0.39). Serum IgG levels were significantly lower in patients on CPD with oligoanuria than in non-oliguric patients (p = 0.04) and in patients on CPD for >90 days as compared to those who had received CPD for <90 days (p = 0.018). IVIG therapy was provided to 20 patients with hypogammaglobulinemia; this high prevalence of IVIG usage precluded any drawing of conclusion on the potential role of IVIG in the prevention of peritonitis. Conclusions: Hypogammaglobulinemia is a frequent complication of CPD during infancy. In our experience, it was not associated with an increased risk for peritonitis.

KW - Hypogammaglobulinemia

KW - Immunoglobulin

KW - Infant dialysis

KW - Neonates

KW - Peritoneal dialysis

UR - http://www.scopus.com/inward/record.url?scp=84990996801&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990996801&partnerID=8YFLogxK

U2 - 10.1007/s00467-016-3487-1

DO - 10.1007/s00467-016-3487-1

M3 - Article

VL - 32

SP - 503

EP - 509

JO - Pediatric Nephrology

JF - Pediatric Nephrology

SN - 0931-041X

IS - 3

ER -