Monitoring of the peritoneal membrane

Struijk, Dirk G.

doi:10.1093/ndtplus/sfn121

Cited by 3 publications

(3 citation statements)

References 86 publications

(67 reference statements)

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“…However, the peritoneal biopsy does not reflect the global changes in the peritoneum and is not feasible and safe to perform within the context of clinical practice [5]. Also, functional tests (peritoneal equilibrium test) cannot differentiate simple peritoneal sclerosis from EPS [6]. Study of extracellular vesicles (EVs) in PD effluent (PDE) may be an alternative approach, a so-called “liquid biopsy”, to investigate peritoneal membrane pathophysiology in lieu of performing a peritoneal biopsy.…”

Section: Introductionmentioning

confidence: 99%

Multiple extracellular vesicle types in peritoneal dialysis effluent are prominent and contain known biomarkers

et al. 2017

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Peritoneal dialysis inevitability results in activation of inflammatory processes and its efficiency is highly variable between patients. An improved method to isolate biomarkers and study pathophysiological mechanisms in peritoneal dialysis effluent (PDE) is expected to be of much benefit for the development of this treatment approach and help with patient management. Extracellular vesicles (EVs) are released as part of normal cellular processes. Their proteome is expected to reflect both type and health of their cell of origin. Although there is a significant interest in using EVs for “liquid biopsies”, little is reported of their presence or composition in plentiful dialysis waste fluids, including peritoneal dialysis effluent (PDE). Here we determined the presence of EVs in PDE and subsequently characterized their proteome. EVs were first isolated from PDE using differential centrifugation, then a further enrichment using size exclusion chromatography (SEC) was performed. The presence of EVs was demonstrated using transmission electron microscopy, and their particle counts were investigated using nanoparticle tracking analysis and dynamic light scattering. Using tandem mass spectrometry, marker proteins from three types of EVs i.e. apoptotic bodies, ectosomes, and exosomes were identified. The proteomic results demonstrated that the isolation of EVs by differential centrifugation helped enrich for over 2,000 proteins normally masked by abundant proteins in PDE such as albumin and SEC markedly further improved the isolation of low abundant proteins. Gene ontology analysis of all identified proteins showed the marked enrichment of exosome and membrane-associated proteins. Over 3,700 proteins were identified in total, including many proteins with known roles in peritoneal pathophysiology. This study demonstrated the prominence of EVs in PDE and their potential value as a source of biomarkers for peritoneal dialysis patients.

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Section: Introductionmentioning

confidence: 99%

Multiple extracellular vesicle types in peritoneal dialysis effluent are prominent and contain known biomarkers

et al. 2017

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“…pH, osmolarity, glucose degradation products, and bioincompatibility) and peritonitis, which lead to loss of the membrane properties that enable efficient treatment [ 18 ]. In clinical practice, that means that peritoneal membrane performances (water and solute mass permeability) should be monitored periodically to detect early deterioration [ 19 ]. In the case of dialysis inadequacy, a switch to another form of RRT should be considered [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

et al. 2022

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Objectives Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients. Methods A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]). Results In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions. Conclusions Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.

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“…These peritoneal equilibration rates reflect peritoneal clearance (PC) and can be calculated using the dialysate-to-plasma ratio (D/P ratio) for any given solute that is transported from the peritoneal capillary blood into dialysate fluid. The transport rate over the peritoneal membrane into the peritoneal cavity is largely size-selective and thus the PC is inversely related to the radius or molecular weight (MW) of a molecule, regardless of molecular properties such as charge or hydrophobicity [20,21,22,23,24]. Therefore, the transport rate of small molecules that are bound to large plasma proteins will be determined by the size of the complex.…”

Section: Introductionmentioning

confidence: 99%

Unraveling Hepcidin Plasma Protein Binding: Evidence from Peritoneal Equilibration Testing

et al. 2019

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Peptide hormone hepcidin regulates systemic iron metabolism and has been described to be partially bound to α2-macroglobulin and albumin in blood. However, the reported degree of hepcidin protein binding varies between <3% and ≈89%. Since protein-binding may influence hormone function and quantification, better insight into the degree of hepcidin protein binding is essential to fully understand the biological behavior of hepcidin and interpretation of its measurement in patients. Here, we used peritoneal dialysis to assess human hepcidin protein binding in a functional human setting for the first time. We measured freely circulating solutes in blood and peritoneal fluid of 14 patients with end-stage renal disease undergoing a peritoneal equilibration test to establish a curve describing the relation between molecular weight and peritoneal clearance. Calculated binding percentages of total cortisol and testosterone confirmed our model. The protein-bound fraction of hepcidin was calculated to be 40% (±23%). We, therefore, conclude that a substantial proportion of hepcidin is freely circulating. Although a large inter-individual variation in hepcidin clearance, besides patient-specific peritoneal transport characteristics, may have affected the accuracy of the determined binding percentage, we describe an important step towards unraveling human hepcidin plasma protein binding in vivo including the caveats that need further research.

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Monitoring of the peritoneal membrane

Cited by 3 publications

References 86 publications

Multiple extracellular vesicle types in peritoneal dialysis effluent are prominent and contain known biomarkers

Multiple extracellular vesicle types in peritoneal dialysis effluent are prominent and contain known biomarkers

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

Unraveling Hepcidin Plasma Protein Binding: Evidence from Peritoneal Equilibration Testing

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