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Krediet RT, Pannekeet MM, Zemel D, Koomen GC, Struijk DG, Hoek FJ. Markers of Peritoneal Membrane Status. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s06] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Ger C.M. Koomen
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam
| | - Dirk G. Struijk
- Renal Unit, Academic Medical Center, Amsterdam
- Foundation for Home Dialysis Midden-West Nederland, Utrecht, the Netherlands
| | - Frans J. Hoek
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam
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Manley HJ, Bailie GR. Effects of Intraperitoneal Cefazolin on Mesothelial Cells in Noninfected CAPD Patients. ARCH ESP UROL 2020. [DOI: 10.1177/089686080102100114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Harold J. Manley
- School of Pharmacy University of Missouri–Kansas City Kansas City, Missouri
| | - George R. Bailie
- Albany College of Pharmacy Albany, New York, U.S.A
- Albany Medical College Albany, New York, U.S.A
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bengt Lindholm
- Department of Clinical Science, Karolinska Institute, Division of Baxter Novum, Huddinge University Hospital, Huddinge, Lund, Sweden
| | - Bengt Rippe
- Department of Nephrology, University Hospital of Lund, Lund, Sweden
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Rippe B, Wieslander A. Biologic Significance of Reduced Levels of Glucose Degradation Products. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bengt Rippe
- Departments of Nephrology and Physiology, University Hospital of Lund
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Koopmans JG, Boeschoten EW, Pannekeet MM, Betjes MG, Zemel D, Kuijper EJ, Krediet RT. Impaired Initial Cell Reaction in Capd-Related Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s69] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Our objective was to determine the incidence of peritonitis episodes with an impaired initial cell reaction (IICR: neutrophil number <100 x 1 061L) over a period often years, and to find possible explanations for this unusual presentation of peritonitis. A retrospective review of the files of continuous ambulatory peritoneal dialysis (CAPD) patients included in the CAPD program between 1984 and 1993 was done. Analysis of cytokine and prostanoid patterns during four peritonitis episodes with an IICR was compared to 12 episodes with a normal initial cell reaction (NICR). Dialysate cell numbers and immunoeffector characteristics of peritoneal cells were compared in 7 IICR patients in a stable situation and a control group of 70 stable CAPD patients. The setting was a CAPD unit in the Academic Medical Center in Amsterdam. Thirty-five CAPD patients who had one or more peritonitis episodes with an IICR and a control group of 249 CAPD patients were included in the study. The incidence of peritonitis with an IICR was 6%. These episodes occurred more than once in 51% of the patients who presented with IICR. In 72% the cell reaction was only delayed: a cell number exceeding 100 x 1 061L was reached later. Staphylococcus aureus was significantly more frequently the causative microorganism compared to all peritonitis episodes (PE) that occurred during the study period. Patients with IICR had lower dialysate cell counts in a stable situation, compared to a control group (p < 0.01). This was caused by a lower number of macro-phages and CD4 positive lymphocytes. The phagocytosis capacity of the macrophages appeared to be normal. In a comparison of four PE with an IICR and 12 episodes with an NICR, the tumor necrosis factor-α (TNF-α) response was similar and occurred on day 1, also pointing to normally functioning macrophages. However, the maximal appearance rates of interleukin-6 (IL-6) and IL-8 occurred later in the episodes with IICR compared to NICR (day 2 vs day 1, p < 0.05). No differences were found in vasodilating prostaglandins, mesothelial cell markers (cancer antigen 125, phospholipids, hyaluronan), and mesothelial cell numbers in the stable situation nor during peritonitis. Peritonitis can present as abdominal pain in the absence of a cloudy dialysate. In some of the patients this presentation occurred more than once. This impaired, most often delayed, cell reaction was associated with a delayed secondary cytokine response. As IL-6 and IL-8 can be synthesized by mesothelial cells, this suggests an impaired functioning mesothelium. This could not be confirmed, however, by a lower number of mesothelial cells in effluent or lower dialysate levels of mesothelial cell markers.
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Affiliation(s)
| | - Elisabeth W. Boeschoten
- Department of Internal Medicine, Renal Unit, Amsterdam
- Foundation for Home Dialysis Midden - West Nederland, Utrecht, the Netherlands
| | | | | | - Désirée Zemel
- Department of Internal Medicine, Renal Unit, Amsterdam
| | - Ed J. Kuijper
- Department of Medical Microbiology, Academic Medical Center, Amsterdam
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Breborowicz A, Korybalska K, Grzybowski A, Tobis KW, Oreopoulos DG, Martis L. Synthesis of Hyaluronic Acid by Human Peritoneal Mesothelial Cells: Effect of Cytokines and Dialysa Te. Perit Dial Int 2020. [DOI: 10.1177/089686089601600410] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess effects of the inflammatory cytokines (IL-1-beta, TNF-alpha, TGF-beta 1) and dialysate effluent on synthesis of hyaluronic acid by human peritoneal mesothelial cells (HMC) in in vitro culture. Methods Dialysate effluent was collected after the overnight dwell of DianeaI 1.5% from patients during CAPD training. HMC were obtained from omentum from nonuremic donors or were harvested from the dialysate effluent from CAPD patients. Synthesis of hyaluronic acid was studied on monolayers of HMC, which were deprived of serum 48 hours priortoexperiment. Effects of cytokines were tested in a medium with low serum concentration (0.1%) or in medium mixed (1:1 v/v) with the autologous dialysate. Hyaluronic acid level in medium was measured with radioimmunoassay. Results Cytokines enhanced synthesis of hyaluronic acid by HMC, and the strongest effect was induced by IL-1. Effluent dialysate stimulates synthesis of hyaluronic acid stronger than 10% FCS. Effluent dialysate and IL-1 synergistically enhance synthesis of hyaluronic acid by HMC. Conclusion Effluent dialysate from CAPD patients stimulates production of hyaluronic acid by HMC and acts synergistically with cytokines.
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Affiliation(s)
| | | | | | | | | | - Leo Martis
- Baxter Healthcare Corporation, McGaw Park, Illinois, U.S.A
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Homma S, Masunaga Y, Kurosu M, Inoue M, Sakurai T, Asano Y. Changes in Peritoneal Coagulation and Fibrinolysis after Discontinuation of Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200203] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
♦ Objectives To study changes in peritoneal function after transfer from chronic peritoneal dialysis (CPD) to hemodialysis (HD), especially the effects on peritoneal coagulation, fibrinolytic markers, and mesothelium. ♦ Design Prospective observational study. ♦ Setting A tertiary-care university hospital. ♦ Patients Nine patients who transferred from CPD to HD were enrolled in the study after giving fully informed consent. ♦ Methods After transfer to HD, the peritoneal cavity was lavaged with low glucose PD solution once per day through PD catheters left in place. Thrombin–antithrombin III complex (TAT) was measured serially as a marker of peritoneal coagulation. As fibrinolytic markers, fibrinogen/fibrin degradation products (FDP) and plasmin–α2-antiplasmin complex (PIC) were assessed. Cancer antigen 125 (CA125) was measured as a marker of mesothelial cell mass. ♦ Results Levels of peritoneal TAT and FDP were much higher than plasma levels, indicating high local fibrin turnover. Transfer to HD induced a significant fall in mean peritoneal TAT, from 115.8 ± 52.1 to 60.7 ± 21.8 ng/mL, p < 0.05. Except for 1 patient with a 20-fold increase, mean peritoneal FDP decreased significantly, from 43.6 ± 11.1 to 19.6 ± 3.5 μg/mL, p < 0.05. Mean peritoneal PIC increased significantly, from 1.9 ± 0.4 to 3.9 ± 0.6 μg/mL, p < 0.05. Peritoneal CA125 increased from 156.4 ± 57.3 to 1426.2 ± 389.4 U/mL, p < 0.05. ♦ Conclusions Peritoneal fibrin turnover was accelerated on CPD and stabilized after transfer to HD. Transfer to HD also induced mesothelial regeneration.
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Affiliation(s)
- Sumiko Homma
- Division of Nephrology, Jichi Medical School, Minamikawachi, Tochigi, Japan
| | - Yoshinori Masunaga
- Division of Nephrology, Jichi Medical School, Minamikawachi, Tochigi, Japan
| | - Megumi Kurosu
- Division of Nephrology, Jichi Medical School, Minamikawachi, Tochigi, Japan
| | - Makoto Inoue
- Division of Nephrology, Jichi Medical School, Minamikawachi, Tochigi, Japan
| | - Toshihiro Sakurai
- Division of Nephrology, Jichi Medical School, Minamikawachi, Tochigi, Japan
| | - Yasushi Asano
- Division of Nephrology, Jichi Medical School, Minamikawachi, Tochigi, Japan
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Krediet RT. Dialysate Cancer Antigen 125 Concentration as Marker of Peritoneal Membrane Status in Patients Treated with Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100605] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveThis study reviews publications on the history of cancer antigen 125 (CA125), the background of its use as a marker of mesothelial cell mass, determination in peritoneal effluent, and its practical use in both the follow-up of peritoneal dialysis (PD) patients and as a marker of in vivo biocompatibility of dialysis solutions.DesignReview article.ResultsCA125 is a high molecular weight glycoprotein. Previous studies in ascites suggested its release by mesothelial cells. In vitro studies with cultured mesothelial cells showed constitutive production, the majority of which was dependent on mesothelial cell mass. Serum CA125 is normal in PD patients, but its concentration in peritoneal dialysate suggests local release, probably from mesothelial cells. Effluent CA125 can be considered a marker of mesothelial cell mass in stable PD patients, but large amounts are found during peritonitis, due probably to necrosis of mesothelial cells. The majority of studies found no relationship between dialysate CA125 and peritoneal transport parameters. Some cross-sectional studies reported a relationship with duration of PD, but others were unable to confirm this, due probably to the large interindividual variability. Longitudinal follow-up has shown a decrease in dialysate CA125, indicating loss of mesothelial cell mass. Application of theoretically morebiocompatible PD solutions causes an increase in dialysate CA125.ConclusionsDialysate CA125 is a mesothelial cell mass marker. The concentration of CA125 should be determined after a standardized dwell. A single low value is not informative. A decrease with time on PD suggests loss of mesothelial cell mass. Dialysate CA125 is a marker of in vivo biocompatibility of (new) dialysis solutions. More research is necessary on the best methodology for measuring low concentrations and establishing normal values and a significant change.
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Martin J. Schreiber
- Department of Nephrology and Hypertension, The Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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Yamagata K, Tomida C, Koyama A. Intraperitoneal Hyaluronan Production in Stable Continuous Ambulatory Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901900210] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Several cytokines and proteins are excreted intraperitoneally during the course of peritonitis and stable states in continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also regarded as a marker of peritoneal healing during bacterial peritonitis. We examined here, intraperitoneal HYA production in stable CAPD patients and compared the results to those of the peritoneal equilibration test (PET), the length of time on dialysis, and other marker proteins. Design We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals. Setting CAPD unit in Hitachi General Hospital. Patients The subjects were 46 stable CAPD patients who underwent 104 PETs. Results A correlation was found between the length of time on dialysis and the amount of HYA excretion in the 4-hr-dwell dialysate ( r = 0.403, p < 0.001). A positive but weak correlation was found between the dialysate-to-plasma ratio of the creatinine concentration and dialysate HYA excretion ( r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both the concentration of HYA (>349.2 ng/mL) and the amount of HYA (>743.6 μg/4-hr dwell). Five patients exceeded 1000 μg of HYA excretion in the 4-hr-dwell dialysate, 4 of whom showed an abrupt increase of HYA excretion to more than 1000 μg/4-hr dwell, and discontinued CAPD within 6 months due to ultrafiltration failure. Two of these 4 patients were diagnosed with sclerosing encapsulating peritonitis at autopsy. Conclusion Intraperitoneal HYA production increased with both higher permeable membrane and the length of time on CAPD. Monitoring of HYA in the peritoneal dialysate may be useful as a marker to assess functional and morphological changes in the peritoneum in long-term CAPD patients.
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Affiliation(s)
- Kunihiro Yamagata
- Department of Nephrology, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Chie Tomida
- Department of Nephrology, Institute of Clinical Medicine, University of Tsukuba, Japan
| | - Akio Koyama
- Hitachi General Hospital, and Department of Nephrology, Institute of Clinical Medicine, University of Tsukuba, Japan
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Abstract
Recent advances in the study of the microcirculation have demonstrated the critical role of the endothelial glycocalyx in transcapillary transport from the plasma to the tissue interstitium. Since the capillary wall represents the initial resistance to solute transfer from the plasma through the tissue to the dialysate, the glycocalyx is potentially of major importance to peritoneal dialysis. Inadvertently removed in early histological studies, this thin, delicate layer of glycosaminoglycans and proteoglycans is now recognized as a primary barrier in transendothelial solute and water transport. Subperitoneal endothelia are exposed to inflammation, angiogenesis, and hyperglycemia, which have been shown to affect the layer by increasing permeability. This entity permits new hypotheses concerning the factors that influence the transport characteristics of peritoneal dialysis patients and provides new avenues of basic research into the fundamental mechanisms of alteration of the peritoneal barrier.
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Affiliation(s)
- Michael F. Flessner
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Hekking LH, van den Born J. Feasibility of Mesothelial Transplantation during Experimental Peritoneal Dialysis and Peritonitis. Int J Artif Organs 2018; 30:513-9. [PMID: 17628852 DOI: 10.1177/039139880703000609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The mesothelial cell layer lining the peritoneum orchestrates peritoneal homeostasis. Continuous exposure to peritoneal dialysis fluids and episodes of peritonitis may damage the monolayer irreversibly, eventually leading to adhesion formation and fibrosis/sclerosis of the peritoneum. Autologous mesothelial cell transplantation is thought to be one of the options to reduce dysfunction of the peritoneal membrane. In this article we will review the mesothelial cell transplantation experiments performed in the field of peritoneal dialysis and peritonitis. In addition we will focus on the trouble shooting using cultured autologous mesothelial cells for transplantation.
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Affiliation(s)
- L H Hekking
- Department of Cellular Architecture and Dynamics, University of Utrecht, Utrecht, The Netherlands
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van Esch S, Struijk DG, Krediet RT. The Natural Time Course of Membrane Alterations During Peritoneal Dialysis Is Partly Altered by Peritonitis. Perit Dial Int 2015; 36:448-56. [PMID: 26526046 DOI: 10.3747/pdi.2014.00215] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 06/15/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The quality of the peritoneal membrane can deteriorate over time. Exposure to glucose-based dialysis solutions is the most likely culprit. Because peritonitis is a common complication of peritoneal dialysis (PD), distinguishing between the effect of glucose exposure and a possible additive effect of peritonitis is difficult. The aim of the present study was to compare the time-course of peritoneal transport characteristics in patients without a single episode of peritonitis-representing the natural course-and in patients who experienced 1 or more episodes of peritonitis during long-term follow-up. ♦ METHODS This prospective, single-center cohort study enrolled incident adult PD patients who started PD during 1990-2010. A standard peritoneal permeability analysis was performed in the first year of PD treatment and was repeated every year. The results in patients without a single episode of peritonitis ("no-peritonitis group") were compared with the results obtained in patients who experienced 1 or more peritonitis episodes ("peritonitis group") during a follow-up of 4 years. ♦ RESULTS The 124 patients analyzed included 54 in the no-peritonitis group and 70 in the peritonitis group. The time-course of small-solute transport was different in the groups, with the peritonitis group showing an earlier and more pronounced increase in the mass transfer area coefficient for creatinine (p = 0.07) and in glucose absorption (p = 0.048). In the no-peritonitis group, the net ultrafiltration rate (NUFR) and the transcapillary ultrafiltration rate (TCUFR) both showed a steep increase from the 1st to the 2nd year of PD that was absent in the peritonitis group. Both groups showed a decrease in the NUFR after year 3. A decrease in the TCUFR occurred only in the peritonitis group. That decrease was already present after the year 1 in patients with severe peritonitis. The time-course of free water transport showed a continuous increase in the patients without peritonitis, but a decrease in the patients who experienced peritonitis (p < 0.01). No difference was observed in the time-course of the effective lymphatic absorption rate. The time-courses of immunoglobulin G and α2-macroglobulin clearances showed a decrease in both patient groups, with a concomitant increase of the restriction coefficient. Those changes were not evidently influenced by peritonitis. The two groups showed a similar decrease in the mesothelial cell mass marker cancer antigen 125 during follow-up. ♦ CONCLUSIONS On top of the natural course of peritoneal function, peritonitis episodes to some extent influence the time-course of small-solute and fluid transport-especially the transport of solute-free water. Those modifications increase the risk for overhydration.
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Affiliation(s)
- Sadie van Esch
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam Nephrology Department and Internal Medicine, St. Elisabeth Hospital, Tilburg
| | - Dirk G Struijk
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam Dianet, Amsterdam-Utrecht, Netherlands
| | - Raymond T Krediet
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam
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Krediet RT. Cancer antigen 125 as a biomarker in peritoneal dialysis: mesothelial cell health or death? Perit Dial Int 2014; 33:715-8. [PMID: 24335135 DOI: 10.3747/pdi.2013.00223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- R T Krediet
- Division of Nephrology Academic Medical Center University of Amsterdam Amsterdam, Netherlands
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van Diepen ATN, van Esch S, Struijk DG, Krediet RT. The first peritonitis episode alters the natural course of peritoneal membrane characteristics in peritoneal dialysis patients. Perit Dial Int 2014; 35:324-32. [PMID: 24711641 DOI: 10.3747/pdi.2014.00277] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/24/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Little or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of peritoneal transport before and after infection. PARTICIPANTS We analyzed prospectively collected data from 541 incident peritoneal dialysis (PD) patients, aged > 18 years, between 1990 and 2010. Standard Peritoneal Permeability Analyses (SPA) within the year before and within the year after (but not within 30 days) the first peritonitis were compared. In a control group without peritonitis, SPAs within the first and second year of PD were compared. MAIN OUTCOME MEASUREMENTS SPA data included the mass transfer area coefficient of creatinine, glucose absorption and peritoneal clearances of β-2-microglobulin (b2m), albumin, IgG and α-2-macroglobulin (a2m). From these clearances, the restriction coefficient to macromolecules (RC) was calculated. Also, parameters of fluid transport were determined: transcapillary ultrafiltration rate (TCUFR), lymphatic absorption (ELAR), and free water transport. Crude and adjusted linear mixed models were used to compare the slopes of peritoneal transport parameters in the peritonitis group to the control group. Adjustments were made for age, sex and diabetes. RESULTS Of 541 patients, 367 experienced a first peritonitis episode within a median time of 12 months after the start of PD. Of these, 92 peritonitis episodes were preceded and followed by a SPA within one year. Forty-five patients without peritonitis were included in the control group. Logistic reasons (peritonitis group: 48% vs control group: 83%) and switch to hemodialysis (peritonitis group: 22% vs control group: 3%) were the main causes of missing SPA data post-peritonitis and post-control. When comparing the slopes of peritoneal transport parameters in the peritonitis group and the control group, a first peritonitis episode was associated with faster small solute transport (glucose absorption, p = 0.03) and a concomitant lower TCUFR (p = 0.03). In addition, a discreet decrease in macromolecular transport was seen in the peritonitis group: mean difference in post- and pre-peritonitis values: IgG: -8 μL/min (p = 0.01), a2m: -4 μL/min (p = 0.02), albumin: -10 μL/min (p = 0.04). Accordingly, the RC to macromolecules increased after peritonitis: 0.09, p = 0.04. CONCLUSIONS The very first peritonitis episode alters the natural course of peritoneal membrane characteristics. The most likely explanation might be that cured peritoneal infection later causes long-lasting alterations in peritoneal transport state.
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Affiliation(s)
- Anouk T N van Diepen
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sadie van Esch
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Nephrology Department and Internal Medicine, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Dirk G Struijk
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Dianet, Amsterdam-Utrecht, The Netherlands
| | - Raymond T Krediet
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Cheema H, Bargman JM. Cancer antigen 125 as a biomarker in peritoneal dialysis: mesothelial cell health or death? Perit Dial Int 2014; 33:349-52. [PMID: 23843586 DOI: 10.3747/pdi.2012.00320] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The concentration or appearance rate of cancer antigen 125 (CA125) in peritoneal dialysis (PD) effluent has been used for many years as a biomarker for mesothelial cell mass in patients on PD. However, this marker has limitations, and emerging evidence has raised doubts as to its significance. This review explores our current understanding of CA125, its prominent role in studies of "biocompatible" PD solutions, and the ongoing uncertainty concerning its interpretation as a measure of mesothelial cell health.
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Affiliation(s)
- Harpaul Cheema
- Division of Nephrology, University Health Network, and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Krediet RT. Prevention and treatment of peritoneal dialysis membrane failure. ADVANCES IN RENAL REPLACEMENT THERAPY 1998; 5:212-7. [PMID: 9686632 DOI: 10.1016/s1073-4449(98)70034-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A review is given on the definition of peritoneal membrane failure, its pathogenesis, mechanisms of impaired ultrafiltration, and prevention and treatment of membrane failure. In the absence of clinical signs of peritoneal sclerosis and of nonresolving peritonitis, membrane failure is best defined as net ultrafiltration of less than 400 mL/4 hours on a 3.86% glucose-based dialysis solution. Evidence has been accumulating that glucose is a major pathogenetic factor. Reduced exposure to glucose is the most important preventive measurement. Strategies for treatment are discussed. The use of icodextrin-based dialysis solutions is an attractive possibility to reduce glucose exposure.
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Affiliation(s)
- R T Krediet
- Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
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Ho-dac-Pannekeet MM. Peritoneal fluid markers of mesothelial cells and function. ADVANCES IN RENAL REPLACEMENT THERAPY 1998; 5:205-11. [PMID: 9686631 DOI: 10.1016/s1073-4449(98)70033-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Peritoneal structural changes are likely to result in functional deterioration of the peritoneal membrane. For the purpose of early detection of these changes, markers of mesothelial cells that can be measured in peritoneal effluent could provide easily accessible information in individual peritoneal dialysis (PD) patients. In this review, current knowledge on a number of these markers is summarized, such as cancer antigen (CA) 125, phospholipids, hyaluronan, and factors involved in the coagulation system. Although only analyzed in limited studies so far, this approach to understanding changes in the peritoneal membrane seems to be valid and warrants further evaluation in the future, especially in combination with functional studies and peritoneal biopsies.
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