OBJECTIVE: To assess the nature of the decline in residual renal function (RRF) after the initiation of peritoneal dialysis, and to identify risk factors influencing the preservation of RRF. DESIGN: A retrospective single-center study. SETTING: Tertiary medical center. PATIENTS: Eighty patients who were clinically stable and had been on continuous ambulatory peritoneal dialysis (CAPD) for a minimum of 6 months. MAIN OUTCOME MEASURES: All subjects had at least three measurements of RRF, which was calculated as the average of creatinine clearance (Ccr) and urea clearance from a 24-hour urine collection. All measurements of RRF were plotted on a logarithmic scale and a linear scale against the duration of CAPD. Covariables used in the correlation analyses were age, sex, the presence of diabetes mellitus, mean blood pressure, mean diastolic blood pressure, hematocrit and Ccr at the start of peritoneal dialysis, peritoneal membrane transport characteristics by peritoneal equilibration test (PET), and the rate of peritonitis. RESULTS: A significant correlation was found between CAPD duration and RRF decline represented on a logarithmic scale with a correlation coefficient (r) of 0.355 (p < 0.001). In contrast, on a linear scale, the correlation coefficient was only 0.273 (p < 0.01). By linear multiple regression analysis, the only independent risk factor for the decline of RRF was the rate of peritonitis (r = -0.446, p < 0.001). CONCLUSION: These results suggest that RRF declines exponentially rather than linearly with time, and that the rate of peritonitis is an independent risk factor for the decline of RRF in CAPD patients.

Female↗

PubMedDate not supplied

High glucose solution and spent dialysate stimulate the synthesis of transforming growth factor-beta1 of human peritoneal mesothelial cells: effect of cytokine costimulation.

OBJECTIVE: To investigate the effect of high glucose and spent peritoneal dialysate on the transforming growth factor-beta1 (TGFbeta1) synthesis of cultured human peritoneal mesothelial cells (HPMCs) and to examine the effect of costimulation with high glucose or spent dialysate, and cytokines, interleukin-1beta (IL-1beta), and tumor necrosis factor-alpha (TNFalpha) on TGFbeta1 synthesis of HPMCs. DESIGN: HPMCs were exposed to different concentrations of glucose (30, 60, and 90 mmol/L) or spent peritoneal dialysate for 48 hours in the absence or presence of IL-1beta (1 ng/mL) and TNFalpha(1 ng/mL).TGFbeta1 mRNA expression was assessed by Northern blot analysis and TGFbeta1 protein release by Western blot analysis and enzyme-linked immunosorbent assay (ELISA). RESULTS: Exposure of HPMCs to high glucose conditions (30, 60, and 90 mmol/L of D-glucose) induced 2.3-, 3.6-, and 4.0-fold increases inTGFbeta1 mRNA expression of HPMC with enhancedTGFbeta1 protein synthesis and secretion into the media, whereas there were no significant changes in TGFbeta1 synthesis with equimolar concentrations of D-mannitol. Incubation with spent dialysate also significantly increased TGFbeta1 mRNA expression and protein secretion compared to control media (p < 0.05). Stimulation with IL-1beta (1 ng/mL) or TNFalpha (1 ng/mL) resulted in a significant increase in TGFbeta1 mRNA expression after 48 hours: 2.7 and 2.1 times the control level, respectively. However,TNFalpha-induced increase in TGFbeta1 mRNA expression was not translated intoTGFbeta1 protein secretion, while IL-1beta stimulation induced a significant increase in TGFbeta1 protein secretion as well as TGFbeta1 mRNA expression. Combined stimulation by high glucose or spent dialysate, together with IL-1beta or TNFalpha, showed a greater increase in TGFbeta1 mRNA expression and protein secretion compared to stimulation by high glucose or spent dialysate alone. CONCLUSION: Our results clearly show that high glucose solution and spent dialysate themselves might be sufficient to stimulate the production of TGFbeta1 by peritoneal mesothelial cells. In peritoneal dialysis patients, this state of chronic induction of TGFbeta1 is further exacerbated in the presence of peritonitis because of the stimulatory effect of proinflammatory cytokines, resulting in augmented TGFbeta1 synthesis, thus promoting peritoneal fibrosis.

Blotting, Northern↗

PubMedDate not supplied

Serum C-reactive protein: a predictor of mortality in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: To evaluate the predictive value of a single baseline serum C-reactive protein (sCRP) as a marker of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A review of prospectively collected data in a 2-year follow-up study. SETTING: Tertiary medical center. PATIENTS: The study included 106 patients who were stable and had been on CAPD for a minimum of 3 months. MAIN OUTCOME MEASURES: Patient survival rate was the main outcome measure of this study. Other outcome measures were technique survival rate, peritonitis rate, and hospitalized days. Covariables used in the survival analysis were age, sex, the presence of cardiovascular disease or diabetes mellitus, sCRP, serum albumin, hematocrit, cholesterol, HDL-cholesterol, malnutrition by subjective global assessment (SGA), weekly Kt/V urea, and weekly standardized creatinine clearance (SCCr). RESULTS: The 2-year patient survival rate was significantly lower in the increased sCRP group than in the normal sCRP group (66.7% vs 94.1%, p = 0.001), although there was no significant difference in technique failure, peritonitis rate, and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were: cardiovascular disease (relative risk, RR = 8.96, p < 0.005); increased sCRP level (RR = 1.19, p < 0.05); and high hematocrit (RR = 1.18, p < 0.05). CONCLUSION: Serum CRP at enrollment is an independent predictor of 2-year patient survival in CAPD patients.

Age Factors↗

PubMedDate not supplied

Impact of total solute clearance on clinical outcomes in Korean CAPD patients.

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Adult↗

PubMedDate not supplied

Recommended peritoneal dialysis curriculum for nephrology trainees. The International Society for Peritoneal Dialysis (ISPD) Standards and Education Subcommittee.

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Adult↗

PubMedDate not supplied

Impact of peritoneal membrane transport characteristics on acid-base status in CAPD patients.

OBJECTIVE: To evaluate the role of individual peritoneal membrane transport characteristics on buffer balance through the peritoneal membrane, and thus on the final acid-base status. DESIGN: Cross-sectional assessment of peritoneal membrane transport characteristics and acid-base status in continuous ambulatory peritoneal dialysis (CAPD) patients. SETTING: Peritoneal dialysis unit in tertiary university hospital. PATIENTS: The study included 143 clinically stable patients maintained on CAPD more than 6 months using 40 mmol/L of lactate-based dialysate. MAIN OUTCOME MEASURE: Comparison of acid-base status based on arterial blood gas analysis, dialytic lactate gain, bicarbonate loss, and total base gain according to membrane transport characteristics as defined by dialysate/plasma creatinine ratio (D/P(Cr)) of standard peritoneal equilibration test (PET). RESULTS: Mean arterial bicarbonate concentration was 24.5 +/- 3.5 mmol/L (16.2-35.7 mmol/L) and mean dialytic base gain was 29.3 +/- 16.7 mmol/day. Only 15 (10.5%) patients showed metabolic acidosis, while 44 (30.8%) patients had various degrees of metabolic alkalosis. Distribution of peritoneal membrane characteristics in our subject showed the highest prevalence of low average (n = 66, 46.2%), followed by high average (n = 54, 37.8%), low (n = 13, 9.1%), and high (n = 10, 6.9%) transporters. The 4-hour D/P(Cr) was positively correlated with dialytic albumin loss, lactate gain, dialytic base gain, arterial pH, and bicarbonate concentration. Lactate gain and dialytic base gain were significantly higher in high transporters, which resulted in increased pH (7.4 +/- 0.03 vs 7.38 +/- 0.03, p < 0.05) and bicarbonate level (26.7 +/- 3.2 vs 23.4 +/- 2.8 mmol/L, p < 0.05) compared to patients with a low transport rate. Multiple regression analysis revealed that lactate gain, duration of peritoneal dialysis, CRP and normalized protein equivalent of nitrogen appearance were the independent factors determining the arterial bicarbonate level. CONCLUSION: The peritoneal membrane transport characteristics can be one of the important factors determining the acid-base status of peritoneal dialysis patients. Duration of dialysis, protein catabolic rate, and acute phase responses of patients also influence arterial bicarbonate level independently. Prospective long-term follow-up studies evaluating the potential role of membrane transport characteristics on acid-base status will be needed to further ascertain the clinical implication of this relationship.

Acid-Base Equilibrium↗