Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable CAPD

Abstract

Objective To investigate whether dialysate concentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue. Design We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation. Setting CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam. Patients Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied. Results All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur. Conclusions Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.

Monitoring of the peritoneal membrane

“…Whether the in vitro experiments can be extrapolated to human situation remains questionable, as studies with more biocompatible dialysate solutions, but still containing glucose, almost universally demonstrated an increase in CA125 concentration in time (see below). CA125 is almost undetectable in lymphocytes, monocytes, granulocytes and fibroblasts [ 24 ], making peritoneal mesothelial cells the most likely source for local CA125 release during PD. In view of the constitutive release after confluence, it can be concluded that CA125 released from mesothelial cells can probably be used for follow-up of mesothelial cell mass in individuals.…”

Invited Editorial: New Concepts in Peritoneal Dialysis: New Wine in Old Barrels?

“…In the Euro-PD-Balance trial, an increase in CA-125 and a decrease of hyaluronic acid concentrations in the drained dialysate during the use of PD-Balance was observed, and these changes disappeared again after switching to the classical glucose solution. Since CA-125 is considered to be a marker of mesothelial cell mass (58), and hyaluronic acid of mesothelial damage (59), this would point to an improved biocompatibility of this solution.…”

Fluid Management and Cardiovascular Outcome in Peritoneal Dialysis Patients

“…( 60) and Ho‐dac‐Pannekeet and Krediet ( 61) have undertaken a survey of the various markers present in PD effluent, which may reflect the status of the peritoneal tissues, especially the mesothelium. At the moment, cancer antigen 125 (CA125) is likely to be the most useful marker of mesothelial cell mass or turnover in stable CAPD patients ( 62). However, no relationship has been found between dialysate CA125 concentrations and the permeability characteristics of the peritoneum ( 63).…”