In this study we investigated the long term results of intraperitoneal
immunoglobulin (Ig) treatment in continuous ambulatory
peritoneal dialyses (
CAPD) patients with refractory or relapsing
peritonitis. Sixteen
CAPD patients (4 female, 12 male) with a mean age of 53 +/- 11 years (40-80), with a mean
CAPD duration of 46.2 +/- 4.8 months (17-75) were included in the study. The patients included had a diagnosis of either refractory or relapsing
peritonitis unresponsive to appropriate
antibiotic therapy. 0.5 g of Ig was added to every exchange bag qid as an adjunctive
therapy to the culture based antibiotherapy for 7 days. Intraperitoneal Ig treatment was found to be successful in treating
peritonitis in all but one patient. Interestingly, following Ig treatment, long term
peritonitis rate decreased significantly compared to the period before treatment (before: 2.2 +/- 0.6 episodes/patient/year vs. after: 0.6 +/- 0.17 episodes/patient/year; P = 0.019). The mean
CAPD duration after Ig treatment was 30.5 +/- 5.4 (4-64) months. Out of 16 patients, one patient who was unresponsive, had his
catheter removed and was switched to
hemodialysis, and four patients with preexisting ultrafiltration failure or inadequate dialysis problems were transferred to
hemodialysis after successful treatment of their
peritonitis, one patient was transplanted and 10 patients continued on
CAPD. We conclude that low dose Ig treatment may be beneficial in the treatment of refractory or relapsing
CAPD peritonitis possibly through restoring impaired host defense within peritoneal cavity. This
therapy, by preventing further
peritonitis attacks, may prolong survival on
CAPD.