The Natural Time Course of Membrane Alterations During Peritoneal Dialysis Is Partly Altered by Peritonitis

Overview

Journal Perit Dial Int

Publisher Sage Publications

Date 2015 Nov 4

PMID 26526046

Citations 9

Authors

Sadie van Esch

Dirk G Struijk

Raymond T Krediet

Affiliations

Soon will be listed here.

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.

Citing Articles

Human peritoneal tight junction, transporter and channel expression in health and kidney failure, and associated solute transport.

Levai E, Marinovic I, Bartosova M, Zhang C, Schaefer B, Jenei H Sci Rep. 2023; 13(1):17429.

PMID: 37833387 PMC: 10575882. DOI: 10.1038/s41598-023-44466-z.

Oxalate Balance in Peritoneal Dialysis Patients: A Potential Role of Dialysis-related Peritonitis.

Stepanova N, Korol L, Lebid L, Snisar L, Savchenko S In Vivo. 2022; 36(2):925-933.

PMID: 35241551 PMC: 8931875. DOI: 10.21873/invivo.12782.

Survival of Peritoneal Membrane Function on Biocompatible Dialysis Solutions in a Peritoneal Dialysis Cohort Assessed by a Novel Test.

Balafa O, Duni A, Tseke P, Rapsomanikis K, Pavlakou P, Ikonomou M J Clin Med. 2021; 10(16).

PMID: 34441945 PMC: 8396924. DOI: 10.3390/jcm10163650.

Comparison of Longitudinal Membrane Function in Peritoneal Dialysis Patients According to Dialysis Fluid Biocompatibility.

van Diepen A, Coester A, Janmaat C, Dekker F, Struijk D, Krediet R Kidney Int Rep. 2020; 5(12):2183-2194.

PMID: 33305111 PMC: 7710881. DOI: 10.1016/j.ekir.2020.09.047.

Glucose Exposure in Peritoneal Dialysis Is a Significant Factor Predicting Peritonitis.

Uiterwijk H, Franssen C, Kuipers J, Westerhuis R, Nauta F Am J Nephrol. 2020; 51(3):237-243.

PMID: 32069459 PMC: 7158228. DOI: 10.1159/000506324.

References

Krediet R . Dialysate cancer antigen 125 concentration as marker of peritoneal membrane status in patients treated with chronic peritoneal dialysis. Perit Dial Int. 2002; 21(6):560-7. View

Zemel D, Koomen G, Hart A, ten Berge I, Struijk D, Krediet R . Relationship of TNF-alpha, interleukin-6, and prostaglandins to peritoneal permeability for macromolecules during longitudinal follow-up of peritonitis in continuous ambulatory peritoneal dialysis. J Lab Clin Med. 1993; 122(6):686-96. View

Davies S, Russell L, Bryan J, Phillips L, Russell G . Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival. Am J Kidney Dis. 1995; 26(2):353-61. DOI: 10.1016/0272-6386(95)90657-6. View

Fernandez-Reyes M, Bajo M, Peso G, Ossorio M, Diaz R, Carretero B . The influence of initial peritoneal transport characteristics, inflammation, and high glucose exposure on prognosis for peritoneal membrane function. Perit Dial Int. 2012; 32(6):636-44. PMC: 3524892. DOI: 10.3747/pdi.2011.00137. View

Imholz A, Koomen G, Voorn W, Struijk D, Arisz L, Krediet R . Day-to-day variability of fluid and solute transport in upright and recumbent positions during CAPD. Nephrol Dial Transplant. 1998; 13(1):146-53. DOI: 10.1093/ndt/13.1.146. View

Yu Z, Lambie M, Davies S . Longitudinal study of small solute transport and peritoneal protein clearance in peritoneal dialysis patients. Clin J Am Soc Nephrol. 2013; 9(2):326-34. PMC: 3913234. DOI: 10.2215/CJN.04420413. View

Perl J, Nessim S, Bargman J . The biocompatibility of neutral pH, low-GDP peritoneal dialysis solutions: benefit at bench, bedside, or both?. Kidney Int. 2011; 79(8):814-24. DOI: 10.1038/ki.2010.515. View

van Diepen A, van Esch S, Struijk D, Krediet R . The first peritonitis episode alters the natural course of peritoneal membrane characteristics in peritoneal dialysis patients. Perit Dial Int. 2014; 35(3):324-32. PMC: 4443991. DOI: 10.3747/pdi.2014.00277. View

Imholz A, Koomen G, Struijk D, Arisz L, Krediet R . Effect of dialysate osmolarity on the transport of low-molecular weight solutes and proteins during CAPD. Kidney Int. 1993; 43(6):1339-46. DOI: 10.1038/ki.1993.188. View

10.

Kinashi H, Ito Y, Mizuno M, Suzuki Y, Terabayashi T, Nagura F . TGF-β1 promotes lymphangiogenesis during peritoneal fibrosis. J Am Soc Nephrol. 2013; 24(10):1627-42. PMC: 3785267. DOI: 10.1681/ASN.2012030226. View

11.

Wong T, Szeto C, Lai K, Lam C, Lai K, Li P . Longitudinal study of peritoneal membrane function in continuous ambulatory peritoneal dialysis: relationship with peritonitis and fibrosing factors. Perit Dial Int. 2001; 20(6):679-85. View

12.

Smit W, Struijk D, Ho-Dac-Pannekeet M, Krediet R . Quantification of free water transport in peritoneal dialysis. Kidney Int. 2004; 66(2):849-54. DOI: 10.1111/j.1523-1755.2004.00815.x. View

13.

Davies S, Bryan J, Phillips L, Russell G . Longitudinal changes in peritoneal kinetics: the effects of peritoneal dialysis and peritonitis. Nephrol Dial Transplant. 1996; 11(3):498-506. View

14.

Pannekeet M, Zemel D, Koomen G, Struijk D, Krediet R . Dialysate markers of peritoneal tissue during peritonitis and in stable CAPD. Perit Dial Int. 1995; 15(6):217-25. View

15.

Johnson D, Brown F, Clarke M, Boudville N, Elias T, Foo M . The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial. Nephrol Dial Transplant. 2012; 27(12):4445-53. PMC: 3520083. DOI: 10.1093/ndt/gfs314. View

16.

Coester A, Smit W, Struijk D, Parikova A, Krediet R . Longitudinal analysis of peritoneal fluid transport and its determinants in a cohort of incident peritoneal dialysis patients. Perit Dial Int. 2013; 34(2):195-203. PMC: 3968105. DOI: 10.3747/pdi.2012.00189. View

17.

Struijk D, Krediet R, Koomen G, Boeschoten E, Hoek F, Arisz L . A prospective study of peritoneal transport in CAPD patients. Kidney Int. 1994; 45(6):1739-44. DOI: 10.1038/ki.1994.226. View

18.

Peso G, Fernandez-Reyes M, Hevia C, Bajo M, Castro M, Cirugeda A . Factors influencing peritoneal transport parameters during the first year on peritoneal dialysis: peritonitis is the main factor. Nephrol Dial Transplant. 2005; 20(6):1201-6. DOI: 10.1093/ndt/gfh793. View

19.

Lai K, Li F, Yui Lan H, Tang S, Tsang A, Chan D . Expression of aquaporin-1 in human peritoneal mesothelial cells and its upregulation by glucose in vitro. J Am Soc Nephrol. 2001; 12(5):1036-1045. DOI: 10.1681/ASN.V1251036. View

20.

Sampimon D, Barreto D, Coester A, Struijk D, Krediet R . The value of osmotic conductance and free water transport in the prediction of encapsulating peritoneal sclerosis. Adv Perit Dial. 2014; 30:21-6. View