High prevalence of selective immunoglobulin A deficiency in peritoneal dialysis patients.

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We encountered two hemodialysis (HD ) patients with recurrent infections and complete immunoglobulin A deficiency (IgAD ). To survey the possibility of a similar occurrence in other populations , we conducted the present study . We used nephelometry to examine the levels of immunoglobulins G (IgG ), A (IgA ), and M (IgM ) in 42 continuous ambulatory peritoneal dialysis (CAPD ) patients , 246 HD patients , 56 chronic renal failure (CRF ) patients , and 250 normal adults . Four CAPD patients (9 .5 %) and five HD patients (2 .0 %) were found to be completely IgA deficient (IgA < 6 .67 mg /dL ). Peritoneal dialysis patients therefore had a significantly higher prevalence of IgAD compared with HD and CRF patients . The underlying diseases leading to dialysis therapy in the IgAD patients varied . Their dialysis durations also varied . The occurrence rate of peritonitis in CAPD patients with IgAD was no higher than in patients without IgAD . The clinical significance of IgAD was focused on mucosal immunity , but the exact prevalence of infection was difficult to define . However , these patients ' medical records did suggest more frequent respiratory tract infections and cellulitis events than did the records of patients without IgAD . Two PD patients with IgAD died of pneumonia . Immunodiffusion and indirect ELISA methods were used to detect the presence of auto-antibodies , successfully identifying them in three patients . Further research is needed to study other mechanisms of IgAD .