Effluent CA 125 Concentration in Chronic Peritoneal Dialysis Patients: Influence of PD Duration, Peritoneal Transport and PD Regimen

Abstract

In terms of the integrity of the peritoneal membrane in peritoneal dialysis (PD), the peritoneal mesothelial cells play a pivotal role since its monolayer constitutes the first line of the peritoneal membrane. Cancer antigen 125 (CA 125) is released by peritoneal mesothelial cells and correlates with the mesothelial cell mass in PD. Since its effluent concentration is easy to determine in chronic PD patients, CA 125 serves as an in vivo marker of biocompatibility. We performed a cross-sectional study to investigate the relation between PD duration, peritoneal transport and the PD regimen (CAPD/CCPD) on effluent CA 125 concentration in 22 chronic PD patients. We compared long-term (>6 months) with short-term PD treatment, patients with high small solute transport properties (MTAC >11 ml/min, d/p ratio of creatinine >0.72) to patients with low small solute transport and CAPD with APD patients. A peritoneal equilibration test was performed with 1.36% glucose. Dialysate/plasma (D/P) ratio and mass transfer area coefficient (MTAC) of creatinine were calculated and the 4-hour effluent concentration of CA 125 was determined. CA 125 tended to be lower in the long-term PD patients and also in APD patients, but statistical significance was missing. Effluent CA 125 was significantly increased in patients with an MTAC of creatinine >11 ml/min (40.2 ± 11.2 vs. 20.7 ± 1.2 U/ml) and in patients with a d/p ratio of creatinine >0.72 (48.2 ± 11.0 vs. 21.6 ± 1.6 U/ml). CA 125 and the d/p ratio of creatinine were positively correlated (r = 0.68). The positive correlation of CA 125 with peritoneal small solute transport especially in the early phase of PD treatment indicates an initial correlation of the mesothelial cell mass with the peritoneal surface area. A direct relation between the CA 125 concentration and peritoneal transport is unlikely. In our study the CA 125 effluent concentration tended to be lower in long-term PD patients and also in APD patients, possibly indicating a cell depletory influence of the conventional PD fluid.

Screening, Diagnosis, and Treatment of Cancer in Long-Term Dialysis Patients

“…Table 4 lists the common tumor markers and their efficacy in dialysis patients. Cancer antigen 125 is a tumor marker for ovarian cancer but is also produced by mesothelial cells (34) and has been reported to be a functional marker for mesothelial cell mass and transport characteristics in patients who are on peritoneal dialysis (35). However, cancer antigen 125 is less useful as a tumor marker in dialysis patients because any serosal fluid (pleural effusion, ascites, etc.)…”

Dialysate CA125 levels in children on continuous peritoneal dialysis

“…Dialysate CA125 levels at the 4th hour ranged between 9 and 65 U/ml, and AR CA125 values were 108-471 U/min/1.73 m 2 [4,13,15,16,17,18,19,20,21]. In all the above-mentioned cross-sectional investigations and also in ours, determination of CA125 a Relation between the stable group and the peritonitis group b Relation between the peritonitis group and the recovery group c Relation between the stable group and the recovery group Fig.…”

“…The majority of cross-sectional studies found no relationship between AR CA125 and age in adults [18,20] or in children [9]. Only one adult study reported a positive correlation between age and AR CA125 levels after correction of these values with body surface area [13].…”

“…Pannekeet et al [18] noted that in adult patients undergoing PD treatment for more than 5 years, significant reduction in dCA125 levels were found. However, others failed to demonstrate a relationship between the duration of PD treatment and CA125 levels [13,17,[20][21][22]25]. Yoshino et al [24] evaluated the changes in PET values in peritonitis-free pediatric PD patients and demonstrated that the most significant changes occurred after 2 years of PD.…”

Volume Control in Peritoneal Dialysis Patients: Role of New Dialysis Solutions

“…At present, none of the conventionally applied PD fluids are entirely biocompatible with respect to toxic effects exerted on cellular and extracellular structures of the peritoneal membrane. During APD with frequent and short dwell times of 0.5-3.0 h, the adverse effects of conventional PD solutions administered freshly during each cycle may accumulate much more over treatment time than during the long dwell periods with CAPD treatment [47,48]. Early biocompatibility studies on peritoneal host defense status comparing patients on long-term CAPD and continuous cyclic PD (CCPD) showed no significant differences with respect to macrophage function or effluent opsonic activity when treatment times were equal [49].…”