1
|
Dong J, Chen Y, Luo S, Xu R, Xu Y. Peritoneal protein leakage, systemic inflammation, and peritonitis risk in patients on peritoneal dialysis. Perit Dial Int 2013; 33:273-9. [PMID: 23284072 DOI: 10.3747/pdi.2011.00326] [Citation(s) in RCA: 18] [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
BACKGROUND Whether peritoneal protein leakage predicts risk for peritonitis in patients on peritoneal dialysis (PD) is unknown. In this observational cohort study, we aimed to determine that association and, further, to explore if it might be explained by systemic inflammation. ♢ METHODS We prospectively followed 305 incident PD patients to first-episode peritonitis, censoring, or the end of the study. Demographics, comorbidity score, biochemistry, and peritoneal protein clearance (PrC) were collected at baseline. The predictors of first-episode peritonitis were analyzed prospectively. ♢ RESULTS During follow-up, 14 868 patient months and 251 episodes of peritonitis were observed. The baseline PrC was 73.2 mL/day (range: 53.2 - 102 mL/day). Patients with a high PrC were prone to be older and malnourished. They also had a higher comorbidity score and higher C-reactive protein values. In 132 first episodes of peritonitis, baseline PrC was shown to be a significant independent predictor after adjustment for age, sex, body mass index, diabetes, residual renal function, hemoglobin, and peritoneal transport rate. Systemic inflammatory markers such as serum albumin, C-reactive protein, and interleukin-6 could not explain the association of PrC and high risk for peritonitis. ♢ CONCLUSIONS Baseline peritoneal protein leakage was able to independently predict risk for peritonitis, which is not explained by systemic inflammation. The underlying mechanisms should be explored in future.
Collapse
Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, PR China.
| | | | | | | | | |
Collapse
|
2
|
Dong J, Luo S, Xu R, Chen Y, Xu Y. Clinical characteristics and outcomes of "silent" and "non-silent" peritonitis in patients on peritoneal dialysis. Perit Dial Int 2012; 33:28-37. [PMID: 22855888 DOI: 10.3747/pdi.2011.00236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We compared the clinical characteristics and outcomes of "silent" peritonitis (meaning episodes without fever and abdominal pain) and "non-silent" peritonitis in patients on peritoneal dialysis (PD). METHODS Our cohort study collected data about all peritonitis episodes occurring between January 2008 and April 2010. Disease severity score, demographics, and biochemistry and nutrition data were recorded at baseline. Effluent cell counts were examined at regular intervals, and the organisms cultured were examined. Treatment failure was defined as peritonitis-associated death or transfer to hemodialysis. RESULTS Of 248 episodes of peritonitis occurring in 161 PD patients, 20.9% led to treatment failure. Of the 248 episodes, 51 (20.6%) were not accompanied by fever and abdominal pain. Patients with these silent peritonitis episodes tended to be older (p = 0.003). The baseline values for body mass index, triglycerides, and daily energy intake were significantly lower before silent peritonitis episodes than before non-silent episodes (p = 0.01, 0.003, and 0.001 respectively). Although silent peritonitis episodes were more often culture-negative and less often caused by gram-negative organisms, and although they presented with low effluent white cell counts on days 1 and 3, the risk for treatment failure in those episodes was not lower (adjusted odds ratio: 1.33; 95% confidence interval: 0.75 to 2.36; p = 0.33). CONCLUSIONS Silent peritonitis is not a rare phenomenon, especially in older patients on PD. Although these episodes were more often culture-negative, silent presentation was not associated with a better outcome.
Collapse
Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, PR China.
| | | | | | | | | |
Collapse
|
3
|
Dong J, Li Y, Yang Z, Luo J, Zuo L. Time-dependent associations between total sodium removal and mortality in patients on peritoneal dialysis. Perit Dial Int 2011; 31:412-21. [PMID: 21357933 DOI: 10.3747/pdi.2010.00103] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To determine if the time-dependent association between total sodium removal and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD) is confounded by markers of diet and nutrition. METHODS The study enrolled 305 incident patients who started CAPD between July 2002 and February 2007. All patients were followed until death or censoring in February 2008. Demographics, blood pressure, and markers of volume and inflammation were collected at baseline. Biochemistry, fluid and solute removal, and diet and nutrition parameters were collected quarterly and thus calculated as time-averaged values. RESULTS Mean age of the study patients was 59.4 years, 42.3% were men, and 40.3% had diabetes. During the 31.4-month follow-up, 74 patients died. The time-averaged daily total sodium removal (TSR) in the overall cohort was 2.67 g (range: 2.02 g-3.47 g). Participants with a high time-averaged TSR tended to experience higher fluid, sodium, urea, and creatinine removal, mainly as a result of better residual renal function (RRF). They also had a higher nutrient intake and a higher lean body mass. Time-dependent TSR was an independent predictor of death, including when adjusted for age, Charlson index, time-dependent hemoglobin, RRF, and peritoneal transport rate (hazard ratio: 0.84; 95% confidence interval: 0.70 to 1.00; p=0.05), but the predictive effect disappeared in multivariate models after further individual adjustment for time-dependent total energy intake, total protein intake, serum albumin, and lean body mass. By contrast, the predictive effect did not disappear if the only adjustment was for time-dependent RRF. CONCLUSIONS The time-dependent association between TSR and mortality in patients on peritoneal dialysis can be largely explained by diet and nutrition parameters.
Collapse
Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, PR China.
| | | | | | | | | |
Collapse
|
4
|
Dong J, Li Y, Xu Y, Xu R. Daily protein intake and survival in patients on peritoneal dialysis. Nephrol Dial Transplant 2011; 26:3715-21. [PMID: 21430179 DOI: 10.1093/ndt/gfr142] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The decreased protein intake may lead to protein-energy wasting and poor survival. It is unknown what the appropriate protein intake in patients on peritoneal dialysis (PD) is. We aimed to explore the appropriate levels of daily protein intake (DPI) in favor of outcome in a large PD cohort. METHODS Our study enrolled 305 incident patients, who could be followed regularly. Demographic data were collected at baseline. Biochemical, dietary and nutritional data and dialysis adequacy were measured at the baseline and thereafter at regular intervals. Outcome events included all-cause death, cardiovascular disease (CVD) death and first-episode peritonitis. RESULTS A total of 127 patients died during the 44.5-month follow-up, 41.7% of whom died from CVD. A total of 129 cases first-episode peritonitis were observed. Patients with a high tertile of baseline DPI (≥ 0.94 g/kg/day) had significantly higher serum albumin, prealbumin, hemoglobin, lean body mass and handgrip strength compared to the low tertile group (≤ 0.73 g/kg/day) (P < 0.05-0.001). They also had significantly lower risk for all-cause, CVD death and first-episode peritonitis than the low tertile group adjusted for commonly recognized confounders. Although patients in the middle tertile of DPI (0.74-0.93 g/kg/day) did not show significant differences in the majority of nutritional markers, all-cause and CVD mortality compared to high tertile group, they had a trend to a negative nitrogen balance and similar risk for first-episode peritonitis to the low tertile group. The DPI included as a time-dependent variable could not predict any outcome events in multivariate Cox models. CONCLUSIONS Our study revealed that DPI <0.73 g/kg/day was associated with protein-energy wasting and worst outcome for PD patients. The DPI >0.94 g/kg/day was in favor of nutrition status and long-term outcome in this population.
Collapse
Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People’s Republic of China.
| | | | | | | |
Collapse
|
5
|
Zhuo M, Dong J, Zheng Y, Zuo L. Are ACEI/ARBs associated with the decreased peritoneal protein clearance in long-term PD patients? Nephrol Dial Transplant 2011; 26:2684-90. [PMID: 21262907 DOI: 10.1093/ndt/gfq764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Objective. Peritoneal protein clearance (PrC) is recognized as a new marker of systemic endothelial dysfunction and predictor of mortality in patients on peritoneal dialysis (PD). Given that angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs) could improve endothelial dysfunction in the general population, we aim to explore whether this benefit is present in the PD population. METHODS We analysed data from a PD cohort with data prospectively collected. The PrC, defined daily doses (DDDs) of ACEI/ARBs, as well as other clinical variables were recorded at baseline and then repeatedly measured at 3- to 6-month intervals till to death or censoring. A total of 156 patients were treated with ACEI/ARBs with 0.60 of median time-averaged DDDs, the untreated group consisted of 149 patients who received none of the above drugs during the follow-up. RESULTS The baseline and time-averaged PrC were 69.9 ± 34.7 mL/day and 75.2 ± 28.3 mL/day, respectively. Time-averaged PrC was an independent predictor of mortality adjusted for recognized confounders in a multivariate Cox regression model (P = 0.037). There were no significant differences in the time course of PrC (P = 0.82) and peritoneal protein loss (P = 0.83) between the ACEI/ARBs group and the untreated group after adjustment for age, gender, diabetes, baseline C-reactive protein, mean blood pressure and baseline PrC or baseline peritoneal protein loss in the generalized linear mixed model. CONCLUSIONS We conclude that ACEI/ARBs did not correlate with a decreased PrC in this observational study. The effect of higher doses of ACEI/ARBs needs to be determined in future interventional studys.
Collapse
Affiliation(s)
- Min Zhuo
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
| | | | | | | |
Collapse
|
6
|
Kolesnyk I, Noordzij M, Dekker FW, Boeschoten EW, Krediet RT. A positive effect of AII inhibitors on peritoneal membrane function in long-term PD patients. Nephrol Dial Transplant 2008; 24:272-7. [DOI: 10.1093/ndt/gfn421] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
7
|
Zhe XW, Tian XK, Cheng L, Wang T. Ultrafiltration capacity and peritoneal fluid kinetics in continuous ambulatory peritoneal dialysis patients. Artif Organs 2008; 32:61-5. [PMID: 18181804 DOI: 10.1111/j.1525-1594.2007.00453.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Volume control is critical for peritoneal dialysis. Although peritoneal equilibration test (PET) has been used to clarify the peritoneal membrane characteristics, it is not able to adequately predict peritoneal fluid removal and optimize appropriately the dwell time. In the present study, we applied computer simulation and performed a more detailed evaluation of the fluid kinetics in patients with different ultrafiltration (UF) capacity. Patients who used three to four exchanges of 2.27% glucose dialysate per day (poor UF capacity group), and patients who used three to four exchanges of 1.36% glucose dialysate per day (good UF capacity group) to achieve adequate amount of peritoneal fluid removal were included in the present analysis. All included patients were asked to record appropriately their dialysis exchanges for the assessment of their peritoneal fluid transport characteristics. Seventeen continuous ambulatory peritoneal dialysis patients were selected in the present study, nine in poor UF capacity group and eight in good UF capacity group. Patients in poor UF capacity group had significantly higher daily glucose exposure, higher dialysate-to-plasma ratio of creatinine (D/P creatinine) values, and higher peritoneal fluid absorption rate, K(e), as compared to patients with good UF capacity. Our results suggest that patients with poor UF capacity have significant higher peritoneal small solute transport rate, and more importantly, higher peritoneal fluid absorption rate as compared to patients with good UF capacity.
Collapse
Affiliation(s)
- Xing-wei Zhe
- Division of Nephrology, Third Hospital, Peking University, Beijing, China
| | | | | | | |
Collapse
|
8
|
Chen W, Guo LJ, Wang T. Extracellular water/intracellular water is a strong predictor of patient survival in incident peritoneal dialysis patients. Blood Purif 2007; 25:260-6. [PMID: 17429200 DOI: 10.1159/000101699] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 02/01/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND The mortality rate of peritoneal dialysis (PD) patients is still high and controversies persist regarding the mortality predictor. This study was designed to identify the predictability of the extracellular water/intracellular water ratio (E/I) on mortality in PD patients. METHODS 227 incident PD patients were included. Time-dependent Cox proportional hazard regression was used to investigate the predictability of E/I on mortality. RESULTS The 2- and 3-year survival was 74 and 65%, respectively. Univariate Cox proportional hazard regression analysis showed that the significant predictors of mortality were age, sex, Charlson Comorbidity Index, total Kt/V, serum albumin, pulse pressure, presence of malnutrition, and E/I. However, the final Cox proportional hazard models revealed that E/I was the only significant predictor. For every increase of 0.1 in the E/I value, the relative risk of death was 1.368. CONCLUSIONS E/I is a strong independent predictor of mortality in incident PD patients.
Collapse
Affiliation(s)
- Wei Chen
- Division of Nephrology, Peking University Third Hospital, Beijing, PR China
| | | | | |
Collapse
|
9
|
Tang W, Cheng LT, Wang T. Diabetic patients can do as well on peritoneal dialysis as nondiabetic patients. Blood Purif 2005; 23:330-7. [PMID: 16118488 DOI: 10.1159/000087771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is not uncommon that diabetic peritoneal dialysis (PD) patients are volume overloaded and this may have contributed to the inferior outcome of diabetic patients. In the present cohort study, we compared the difference between diabetics and nondiabetics during the first year of PD after implementing strict volume control. METHODS Seventeen diabetic and 40 nondiabetic incident PD patients were followed for 1 year. Fluid status was evaluated by bioimpedance analysis and blood pressure. Nutritional status was evaluated by subjective global nutritional assessment. RESULTS At the initiation, compared with the nondiabetics, diabetics had a significantly higher extracelluar volume, systolic blood pressure and lower serum albumin. One year later, there were no statistical differences in these parameters between the two groups. The prevalence of malnutrition decreased in all patients, although malnutrition remained slightly higher in diabetic patients. CONCLUSIONS Our study suggests that diabetics can do as well as nondiabetics on PD. Appropriate diabetic care, especially strict volume control, may be critical for the success of diabetic patients on PD treatment.
Collapse
Affiliation(s)
- Wen Tang
- Institute of Nephrology, First Hospital, Peking University, Beijing, China
| | | | | |
Collapse
|
10
|
Cheng LT, Tang W, Wang T. Strong Association Between Volume Status and Nutritional Status in Peritoneal Dialysis Patients. Am J Kidney Dis 2005; 45:891-902. [PMID: 15861355 DOI: 10.1053/j.ajkd.2005.01.037] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Malnutrition is a strong predictor of mortality in maintenance peritoneal dialysis (PD) patients. Various factors have been identified to contribute to the development of malnutrition. The present study tried to investigate the possible role of fluid overload in the development of malnutrition. METHODS Twenty-eight PD patients were included in this study. Fluid status was evaluated by means of repeated bioimpedance analysis, and nutritional status was assessed by means of handgrip strength and subjective global assessment. All patients were followed up closely for 9 months. Based on changes in bioimpedance analysis data, patients were divided into group A (with continuous and steadily improved fluid status; n = 18) and group B (with consistent fluid overload; n = 10). RESULTS There were no differences in sex, age, and height between the 2 groups. In group A, patients' extracellular water (ECW) volume decreased significantly during follow-up, whereas intracellular water (ICW) volume increased significantly (both P < 0.001). In group B, ECW volume increased significantly, whereas ICW volume increased at an early stage and then decreased. The ratio of ECW to total-body water decreased significantly in group A, but increased significantly in group B. Along with the improvement in fluid status, nutritional status in group A also improved significantly (the prevalence of malnutrition decreased from 66.7% to 11.1%; P < 0.01). However, in group B, nutritional status deteriorated significantly (handgrip strength decreased from 238.33 +/- 88.93 to 216.1 +/- 86.19 N; P < 0.05; and the prevalence of malnutrition increased from 40% to 50%). CONCLUSION Our data suggest there is a strong association between fluid status and nutritional status. Improved fluid status is associated with improvement in nutritional status, whereas deterioration in fluid status is associated with the development of malnutrition.
Collapse
Affiliation(s)
- Li-Tao Cheng
- Institute of Nephrology, First Hospital, Peking University, Beijing, PR China
| | | | | |
Collapse
|
11
|
Szeto CC, Chow KM, Poon P, Szeto CYK, Wong TYH, Li PKT. Genetic polymorphism of VEGF: Impact on longitudinal change of peritoneal transport and survival of peritoneal dialysis patients. Kidney Int 2004; 65:1947-55. [PMID: 15086939 DOI: 10.1111/j.1523-1755.2004.00605.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) plays a pivotal role in the peritoneal angiogenesis and hyperpermeability in patients on peritoneal dialysis. We hypothesis that VEGF genetic polymorphism may affect the longitudinal change of peritoneal transport and clinical outcome of peritoneal dialysis patients. METHODS We studied 135 consecutive new peritoneal dialysis patients. VEGF genetic polymorphism at -1154 and -2578 positions were determined by polymerase chain reaction (PCR) methodologies. Standard peritoneal test and dialysis adequacy and transport test (DATT) were performed at the initiation of peritoneal dialysis. After 12 months, DATT was repeated in 83 patients. In 35 patients, VEGF production in vivo was determined by its levels in serum and peritoneal dialysis effluent, and mRNA expression in peritoneal dialysis effluent. Patients were followed for 19.4 +/- 8.5 months for survival study. RESULTS There was no relation between VEGF genotype and baseline peritoneal transport group. The changes in 24-hour dialysate-to-plasma (D/P) creatinine after 12 months were 0.028 +/- 0.159, -0.013 +/- 0.137, and 0.141 +/- 0.231 for CC, CA, and AA genotype at -2578 position, respectively [one-way analysis of variance (ANOVA), P= 0.028]. The AA genotype had significantly higher increase in 24-hour D/P creatinine than the other genotypes. Similar results were found with the genotype at -1154 position, which had marked linkage disequilibrium with the genotype at -2578 position. Actuarial patient survival was 90.3% and 74.9% at 24 months for CC and CA/AA genotypes at -2578 position, respectively (P= 0.036). After correcting for confounding covariates, the adjusted hazard ratio of death was 3.04 (95% CI, 1.10 to 8.36) for the CA/AA group as compared to CC group. Although baseline serum VEGF level was higher in patients with CC genotype than those with CA/AA genotype at -2578 position (541.5 +/- 322.8 pg/mL vs. 298.8 +/- 209.4 pg/mL, P= 0.012), VEGF mRNA expression in peritoneal dialysis effluent was significantly lower in patients with CC genotype (1.82 +/- 2.77 vs 4.48 +/- 3.28, P= 0.021). VEGF protein level in peritoneal dialysis effluent was also marginally lower in patients with CC genotype, although the difference was not significant. Genotype at -1154 position was not associated with VEGF production in vivo or patient survival. CONCLUSION We conclude that in peritoneal dialysis patients, the AA genotype of VEGF promoter at -2578 position was associated with progressive increase in peritoneal transport. The CA/AA genotype at -2578 position was also associated with an excess mortality. Our finding also suggests that systemic and local peritoneal VEGF production may be differentially regulated.
Collapse
Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
12
|
Szeto CC, Wong TYH, Chow KM, Leung CB, Li PKT. Dialysis adequacy and transport test for characterization of peritoneal transport type in Chinese peritoneal dialysis patients receiving three daily exchanges. Am J Kidney Dis 2002; 39:1287-99. [PMID: 12046043 DOI: 10.1053/ajkd.2002.33405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dialysis adequacy and transport test (DATT) is an accurate method to classify peritoneal transport type for continuous ambulatory peritoneal dialysis (CAPD) patients with a regimen of four exchanges of 2 L/d. We examined the accuracy of DATT for the characterization of peritoneal transport type in patients with a regimen of three exchanges of 2 L/d, which is the standard CAPD regimen in Hong Kong Chinese. We studied 189 adult Chinese CAPD patients with a prescription of three exchanges of 2 L/d. Patients who had a peritonitis episode within the previous 30 days were excluded. Standard peritoneal equilibration test (PET) and DATT were performed on consecutive days. Correlation coefficients between dialysate-to-plasma ratios of creatinine (D/P) obtained for the PET and the DATT was 0.698 (P < 0.001). Peritoneal transport type was classified according to the reported D/P creatinine reference values obtained from the PET at 4 hours. When the result was compared with the transport type classified by the DATT result using the linear regression formula derived, the Cohen kappa was 0.433 (95% confidence interval, 0.329 to 0.537), which could be regarded as a moderate level of agreement. For classification of the low transporters, the specificity of DATT was 90.1%, and sensitivity was 72.3%. For classification of the high transporters, the specificity of DATT was 96.6%, and sensitivity was 57.1%. DATT and PET had a reasonable agreement in the classification of peritoneal transport type for Chinese CAPD patients receiving a daily schedule of three exchanges of 2 L/d. Although DATT may be less accurate for CAPD patients with three daily exchanges, it remains a specific method to identify low and high transporters.
Collapse
Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | | | | | | | | |
Collapse
|
13
|
Szeto CC, Poon P, Szeto CYK, Wong TYH, Lai KB, Li PKT. Plasminogen activator inhibitor-1 4G/5G genetic polymorphism does not affect peritoneal transport characteristic. Am J Kidney Dis 2002; 39:1061-7. [PMID: 11979351 DOI: 10.1053/ajkd.2002.32790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There is evidence that type 1 plasminogen activator inhibitor (PAI-1) may have an important role in peritoneal function. We studied the effect of physiologically relevant PAI-1 promotor polymorphisms on peritoneal permeability. We performed a standard peritoneal equilibration test (PET) in 100 new continuous ambulatory peritoneal dialysis (CAPD) patients. We studied another 48 prevalent CAPD patients who had a baseline PET performed 2 years before; a standard PET was repeated on enrollment. The PAI-1 promotor polymorphism was examined. All patients then were followed up for 16.7 +/- 15.0 months. Prevalences of 4G/4G, 4G/5G, and 5G/5G genotypes were 31.8%, 46.6%, and 21.6%, respectively. Of the 100 new CAPD patients, there was no difference in net ultrafiltration (UF), dialysate-plasma (D/P) creatinine ratio at 4 hours, or mass transfer area coefficient (MTAC) of creatinine among the three genotype groups. D/P creatinine ratios at 4 hours were 0.595 +/- 0.133, 0.607 +/- 0.137, and 0.627 +/- 0.142 for the 4G/4G, 4G/5G, and 5G/5G groups, respectively (one way analysis of variance, P = 0.715). Of the 48 prevalent patients, PAI-1 genotype did not affect the longitudinal change in net UF, D/P creatinine ratio at 4 hours, or MTAC of creatinine. During follow-up, 16 patients developed peritonitis episodes that required Tenckhoff catheter removal. One patient died, 8 patients returned to long-term CAPD therapy after peritonitis resolved, and the other 7 patients developed peritoneal failure and were switched to long-term hemodialysis therapy. PAI-1 promotor genotype did not predict peritoneal failure after an episode of severe peritonitis (chi-square test, P = 0.328). We conclude that PAI-1 promotor polymorphism is not associated with peritoneal transport characteristics in stable peritoneal dialysis patients, longitudinal change in peritoneal transport, or development of peritoneal failure after an episode of severe peritonitis.
Collapse
Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | | | | | | | | | | |
Collapse
|
14
|
Jager KJ, Merkus MP, Dekker FW, Boeschoten EW, Tijssen JG, Stevens P, Bos WJ, Krediet RT. Mortality and technique failure in patients starting chronic peritoneal dialysis: results of The Netherlands Cooperative Study on the Adequacy of Dialysis. NECOSAD Study Group. Kidney Int 1999; 55:1476-85. [PMID: 10201013 DOI: 10.1046/j.1523-1755.1999.00353.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent studies have shown an association between small solute clearance and patient survival. Thus far, little attention has been paid to the potential effects of fluid overload. The aim of this study was to determine the relative importance of baseline patient and treatment characteristics to mortality and technique failure in patients starting peritoneal dialysis. METHODS One hundred and eighteen consecutive new patients were included in this prospective multicenter cohort study. Cox proportional hazards regression was used to predict mortality and technique failure. RESULTS There were 33 deaths and 44 technique failures. The two-year patient survival was 77%, and the two-year technique survival was 64%. Age, systolic blood pressure, and the absolute quantity of small solutes removed at baseline were independent predictors of mortality. A one-year increase in age was associated with a relative risk (RR) of death of 1.05 (95% CI, 1.01 to 1.09) and a 10 mm Hg rise in systolic blood pressure, with a RR of 1.42 (95% CI, 1.17 to 1.73). The removal of 1 mmol/week/1.73 m2 of urinary and dialysate creatinine was associated with a RR of death of 0.95 (95% CI, 0.92 to 0.98) and 0.93 (95% CI, 0.89 to 0.98). The removal of urea had a similar association with the RR of death. Predictors for technique failure were urine volume, peritoneal ultrafiltration, and systolic blood pressure. CONCLUSIONS Dialysate solute removal was an independent predictor of mortality. The association between systolic blood pressure and mortality shows that the maintenance of fluid balance and the removal of small solutes deserve equal attention.
Collapse
Affiliation(s)
- K J Jager
- Department of Nephrology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
The evaluation of ultrafiltration failure is embarked upon when a patient has persistent problems with symptoms and signs of fluid overload. Fluid overload is a common problem in peritoneal dialysis (PD) patients and the risk of its occurrence increases with time on dialysis. Although often attributed to changes in peritoneal membrane function (membrane failure), there are a number of potential, and frequently more common factors that can contribute to the failure of adequate fluid removal in patients on PD. Many of the causes of ultrafiltration failure may be apparent after an initial informal evaluation. However, if after this the etiology remains unexplained, a systematic approach to the differential diagnosis of this problem can be utilized with the use of the peritoneal equilibration test. Once a diagnosis is confirmed, a logical therapeutic plan can be formulated.
Collapse
Affiliation(s)
- S M Korbet
- Section of Nephrology, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, USA
| |
Collapse
|