Neutrophil phagocytic dysfunction in children with chronic kidney disease

Background and aims
In chronic kidney disease (CKD), neutrophils exhibit a reduced capacity to phagocytize and eliminate bacteria. Underlying mechanisms remain poorly understood, particularly in pediatric CKD patients. We aimed to assess neutrophil phagocytic function in pediatric CKD patients, infections, and hospital admissions.


Patients and methods
A cross–sectional study included CKD patients between 2 and 18 years, who were divided equally into: CKD group on conservative management, CKD on conventional type of hemodialysis (HD), and CKD on online hemodiafiltration. Patients with known primary immune deficiency, neutropenia were excluded. We obtained data of frequency and types of infection, hospitalization, and tested for neutrophil phagocytic function by dihydrorhodiamine test.


Results
We included 66 comparable patients, with a mean ± SD age of 10.46±3.58 years, where 36.36% of them had infections, on an average of three times. Respiratory tract and bacterial infections were the most common (81.82%, 83.33%, respectively). Hospitalization was reported in 68.18%, where catheter-related blood stream infection was reported in 18.18%. Dihydrorhodiamine had a defective response in 3.03%. CKD stage, HD modality, had no significant influence on infection rate, or hospital admissions.


Conclusion
Neutrophil phagocytic dysfunction is not uncommon in pediatric CKD patients. Bacterial and respiratory tract infections are common, and hospitalization is frequently reported due to catheter-related blood stream infection and sepsis. CDK stage and HD modality had no significant association with infections and hospitalization. These findings emphasize the need for vigilant infection prevention strategies in this vulnerable population.