ABSTRACT
Introduction: Chronic kidney disease (CKD) patients are moresusceptible to infection due to impaired immune competency.Age, nutritional deficiencies, uremic toxins, dialysis,metabolism of parathyroid hormones and immunosuppressivemedications contribute to immune dysregulation. Aims ofthe present study were to find out the use of Candin Test toearly reorganization of immunocompromised state of cellularimmunity in patients of CKD and to find out correlationbetween Candin Test results and various factors alteringimmune system in CKD patients.Material and methods: The Cross-sectional observationalstudy was conducted on eighty adult patients qualifying thediagnostic criteria as per KDIGO guideline. Another ageand sex matched eighty healthy volunteers were selectedas control group. Patients having diabetes, HIV positive,malignancy, pregnancy, who are on steroids or any otherimmunosuppressive therapy, and those belonging to extremesof ages i.e.<18 years and >65 years were not included in thestudy. A detailed history, clinical examination and relevantinvestigations (Serum urea, creatinine, FBS, HIV, iPTH andUSG abdomen) were done in each subject. Each subject alsounderwent Candin Test to assess the level of cellular immunity.Result: Out of 80 cases, 35% patients showed positiveinduration while control group (n=80) demonstrated 58.8%indurations that revealed significantly more induration positivein controls (p=0.0024). In stage 3 CKD patients, 55.5% casesshowed positive induration, however positive indurationdecreases 52% and 24% in stage 4 and stage 5 respectively.Induration was significantly more positive in stage 3 and stage4 in comparison to stage 5 (p=0.007). Longer duration of CKDshowed lesser number of positive induration response butdifference was statistically non-significant (p=0.0521). Therewas significantly more induration response in no hemodialysisgroup (p=0.032) in comparison to hemodialysis group. Nosignificant difference was observed between induration andage. Mean eGFR of the patients with positive induration was20.14±13.083 and those without induration was 12.87±7.968with p=0.003, which is significant i.e. cases with positiveinduration have higher eGFR values. Mean Serum iPTH is215.50±119.279 in patients with positive induration and312.88±286.601 in patients with no induration which is notsignificant (p=0.091).Conclusion: Our study emphasises that Candin Test maybe useful to predict anergy in patients of CKD. As the CKDpatients approaches towards ESRD, cellular immunityalso decreases. It has also been observed that Candin Testresponse was diminished in patients on maintenance HD,which explains that as the frequency of HD increases patient'simmunity decreases.