Dialysate CA125 levels in children on continuous peritoneal dialysis

Abstract

This prospective study was conducted to assess dialysate cancer antigen 125 (dCA125) levels in pediatric peritoneal dialysis (PD) patients and to investigate whether it exhibits any alterations during or after recovery from peritonitis, and also to analyze the relationships between dCA125 and age, duration of PD treatment, peritonitis incidence, time passed since the last episode of peritonitis, PD prescription parameters, and peritoneal transport parameters. Forty-seven standardized 4-h peritoneal equilibration tests (PET) were performed in 38 children (mean age 11.6+/-4.7 years) on PD (duration 20.9+/-14.3 months). Thirty-two of the patients were in stable condition at the time of PET (stable group). Six patients were included in the study only during a peritonitis episode, and two of the stable patients were reevaluated during a peritonitis episode afterwards (peritonitis group). Seven out of a total of eight patients with acute peritonitis were reexamined after recovery (recovery group). CA125 levels were measured in 188 samples at 0-, 1-, 2-, and 4-h dwells. Peritoneal appearance rates (AR) were calculated. Mean dCA125 (4 h) and AR CA125 values were 5.6+/-5.3 U/ml [median 4.15 U/ml/4 h (range 0.5-25.9)] and 50.1+/-45.6 U/min/1.73 m2[median 37.91 U/ml/1.73 m2 (range 3.61-223.39)]. AR CA125 levels did not correlate with age, PD duration, peritonitis incidence, time passed since the last peritonitis episode, exchange volume used per m2 per day, or peritoneal transport properties in the stable patients' group. Although stable patients using hypertonic PD solutions (n=16) had slightly lower AR CA125 levels (p=0.04), multivariate analysis showed no influence of hypertonic dextrose solutions on mesothelial CA125 secretion (p=0.4). During acute peritonitis, CA125 concentrations showed a reversible threefold increase [AR CA125: stable 37.9 vs. peritonitis 101.2 U/ml/1.73 m2 (p=0.001)]. No difference could be found between the stable group and the recovery group. We conclude that changes in the peritoneal mesothelial cell mass cannot be assessed by determining CA125 in a cross-sectional way and that longitudinal determinations could be more valuable in the follow-up of patients.

Effects of Icodextrin and Glucose Bicarbonate/Lactate‐Buffered Peritoneal Dialysis Fluids on Effluent Cell Population and Biocompatibility Markers IL‐6 and CA125 in Incident Peritoneal Dialysis Patients

“…This is a new finding as it was believed that neither the type of the osmotic agent in the solution nor the glucose level actually has an effect of CA125 . The discrepancies may be explained by different methodology such as short dwell (only 4 h), small number of patients (only five patients), non‐standardized dwell time ranging between 8 and 16 h, examination of prevalent patients with varied duration of peritoneal dialysis in their history, and the pediatric population in previous studies . The design of our study used a standardized dwell time of 10 h with incident patients examined in a prospective study.…”

Dialysate CA125 levels after 5 years on continuous peritoneal dialysis

“…This downward trend with time suggests a decrease in mesothelial cell mass. In an earlier cross-sectional analysis [18], we failed to observe a correlation between dCA125 levels and the duration of PD and had speculated that significant mesothelial cell mass reduction is unlikely to occur within the first few years of PD treatment. On the other hand, in a longitudinal study, Rodrigues et al showed a significant decrease in effluent CA125 levels after 3 years of PD treatment [16].…”

“…We previously published a cross-sectional study of dCA125 levels and peritoneal transport parameters in a group of 32 pediatric PD patients [18]. Of these children, 11 were still on PD at the time of writing this paper; these children comprised the patient group of this study.…”