Orosomucoid can predict baseline peritoneal transport characteristics in peritoneal dialysis patients and reduce peritoneal proteins loss

Abstract

Background: Peritoneal dialysis (PD) is a kind of replacement therapies for end-stage renal disease (ESRD) patients. In the rst 4-8 weeks of PD therapy, the patients were given an empirical dialysis prescription due to unknown peritoneal transport characteristics.Methods: Proteomic analysis was used to identify serum biomarkers which can predict the baseline peritoneal transport characteristics.Results: A discovery set of serum samples from ESRD patients were collected. After 4-8 weeks of PD therapy, these patients were divided into three groups according to the peritoneal equilibration test (PET) results: high (H), high average (HA), low average and low (LA&L) transporters. A total of 1051 differential proteins were screened by nano High Performance Liquid Chromatography -Mass Spectrometry / Mass Spectrometry (Nano HPLC-MS/MS). The top two proteins among different peritoneal transport characteristics were Orosomucoid 2 (ORM2) and C-reactive protein (CRP). To verify the above biomarkers, a larger population of PD patients were enrolled. Immunoturbidimetric assay showed that CRP was signi cantly elevated in H group than LA&L group, consistent with the result of proteomic analysis. Western blot validated that ORM2 in serum was increased in LA&L group compared with H and HA group. The expression of ORM2 in peritoneum also altered progressively in three groups. At last, supplying exogenous ORM could actually change peritoneal substances transport by reducing peritoneal proteins loss, without causing an excessive pro-in ammatory response in mice.Conclusions: Serum ORM2 and CRP could be used as biomarkers to predict the baseline peritoneal transport characteristics, so as to guide the early PD treatment. ORM also raised the possibility of decreasing peritoneal proteins loss in PD patients. BackgroundPeritoneal dialysis (PD) is an effective, convenient and safe treatment for end-stage renal disease (ESRD) patients. PD therapy implies a peritoneal catheter set in peritoneal cavity, with a long-term glucose dialysate exchange to eliminate toxins.Peritoneal equilibration test (PET) developed by Twardowski[1] divided the peritoneal transport characterics as low (L), low average (LA), high average (HA), and high (H). Patients with higher transport characteristics need shorter dialysate dwell times, and have poorer nutrition status and prognosis as a signi cant independent risk factor for death [2][3][4]. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines suggest that the rst PET should be performed 4-8 weeks after PD start. During this waiting period, the patients was given an empirical dialysis prescription due to unknown peritoneal transport characteristics. If we nd biomarkers to predict the baseline peritoneal transport characteristics before PD commencement, we could give an accurate PD prescription as soon as PD start instead of waiting for 4-8 weeks.The peritoneal transport characteristics change with dialysis vintage and peritonitis episodes after PD start [5]. However, before PD start, the baseline pe...

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“…Peritoneal dialysis (PD), a type of dialysis, is a choice cure for sufferers with renal failure or peritonitis [1,2]. It makes use of the peritoneal membrane (PM) of human body as a semipermeable membrane to get rid of metabolites and toxic substances in the body and correct the imbalance of water and electrolyte balance via nonstop changes of the dialysate fluid in the abdominal cavity [3,4].…”