Assessment of phagocytic activity of polymorphonuclear leukocytes in hospitalized patients with Stages 4 and 5 chronic kidney disease

Abstract

Background: Infections are the main reason for hospitalization and the second common cause of death in chronic kidney disease (CKD) patients. Infections develop primarily as a consequence of deranged innate immunity. In this study, we assessed the efficiency of phagocytic function of polymorphonuclear (PMN) leukocytes in severe CKD patients. Aims and Objectives: The aims of the study were (i) to assess the phagocytic index and lytic index of PMN leukocytes (PMNLs) in Stages 4 and 5 CKD patients. (ii) To compare the above indices with healthy age and sex-matched controls. Materials and Methods: The study was carried out in 60 adults in the age group of 18–60 years of which 30 were CKD patients in Stages 4 and 5 taking conservative treatment (not on dialysis) and other 30 were age and sex-matched controls. After screening for inclusion and exclusion criteria, 5 ml of venous blood was collected and taken immediately for evaluation. Phagocytic index which is the number of neutrophils positive for ingested microbes per 100 neutrophils and lytic index which is the total number of microbes per 100 cells were calculated. These are indices of neutrophil functioning. Results: Statistically significant decrease in both phagocytic index and lytic index were found in Stages 4 and 5 CKD patients as compared to controls. Conclusion: In the present study, we were able to establish that phagocytic capacity of PMNLs is adversely affected in severe CKD patients. This gains importance in the light of immune dysfunction being considered as a major cause of premature deaths resulting from infections in severe CKD.