Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution

BMC Nephrology

Eisei Noiri⁵  Masaomi Nangaku⁵  Yukio Homma²  Toshiro Fujita⁴  Yutaka Enomoto⁶  Yoshitaka Ishibashi¹  Haruki Kume²  Mototsugu Tanaka⁵  Kent Doi⁷  Yoshifumi Hamasaki³ 

[1] Japanese Red Cross Medical Center, Tokyo, Japan;Urology, The University of Tokyo Hospital, Tokyo, Japan;22nd Century Medical and Research Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan;Division of Clinical Epigenetics, Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, Tokyo, Japan;Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan;Mitsui Memorial Hospital, Tokyo, Japan;Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan

关键词: Peritoneal permeability;    Peritoneal equilibration test;    Peritoneal dialysis;    Cardiovascular disease;    Biocompatible peritoneal dialysis solution;   

Others  :  1082585
DOI  :  10.1186/1471-2369-15-173

 received in 2014-07-17, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical factors at peritoneal dialysis initiation, including peritoneal transport status, are associated with cardiovascular event in patients using biocompatible peritoneal dialysis solution.

Methods

This retrospective cohort study of peritoneal dialysis patients using biocompatible solutions with neutral pH assessed relations of clinical parameters at peritoneal dialysis initiation to cardiovascular event during the subsequent five years.

Results

Of 102 patients who started peritoneal dialysis, cardiovascular event occurred in 18. Age, history of cardiovascular disease before peritoneal dialysis initiation, hemoglobin, serum albumin, C-reactive protein, peritoneal permeability defined by the ratio of dialysate to plasma creatinine concentration at 4 hr (D/Pcre) in peritoneal equilibration test (PET), number of patients in each PET category defined by D/Pcre, and peritoneal protein clearance significantly differed between patients with and without cardiovascular event. For patients divided according to PET category using Kaplan–Meier method, the group of high average to high peritoneal transporters exhibited significantly high incidence of cardiovascular event and mortality compared with the groups of low and low-average peritoneal transporters (Log rank; p = 0.0003 and 0.005, respectively). A Cox proportional hazards model showed independent association of PET category classification with cardiovascular event.

Conclusions

Peritoneal permeability expressed as PET category at peritoneal dialysis initiation is an independent cardiovascular risk factor in peritoneal dialysis patients using biocompatible peritoneal dialysis solution with neutral pH. Greater peritoneal permeability at peritoneal dialysis initiation might reflect subclinical vascular disorders.

【 授权许可】

   
2014 Hamasaki et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De Meester J, Wetzels JF, Rosendaal FR, Dekker FW: Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 2009, 302(16):1782-1789.
• [2]Lameire N, Van Biesen W: Epidemiology of peritoneal dialysis: a story of believers and nonbelievers. Nat Rev Nephrol 2010, 6(2):75-82.
• [3]Krediet RT, Balafa O: Cardiovascular risk in the peritoneal dialysis patient. Nat Rev Nephrol 2010, 6(8):451-460.
• [4]Perez-Fontan M, Rodriguez-Carmona A, Barreda D, Lopez-Muniz A, Blanco-Castro N, Garcia-Falcon T: Peritoneal protein transport during the baseline peritoneal equilibration test is an accurate predictor of the outcome of peritoneal dialysis patients. Nephron Clin Pract 2010, 116(2):c104-c113.
• [5]Perl J, Huckvale K, Chellar M, John B, Davies SJ: Peritoneal protein clearance and not peritoneal membrane transport status predicts survival in a contemporary cohort of peritoneal dialysis patients. Clin J Am Soc Nephrol 2009, 4(7):1201-1206.
• [6]Twardowski ZJ, Nolph KD, Khanna R, Prowant BF, Ryan LP, Moore HL, Nielsen MP: Peritoneal equilibration test. Periton Dialys B 1987, 7(3):138-147.
• [7]Elsurer R, Afsar B, Sezer S, Ozdemir FN, Haberal M: Peritoneal albumin leakage: 2 year prospective cardiovascular event occurrence and patient survival analysis. Nephrology (Carlton) 2009, 14(8):712-715.
• [8]National Kidney Foundation: Clinical practice recommendations for peritoneal dialysis adequacy. Am J Kidney Dis 2006, 48 Suppl 1:S130-S158.
• [9]Churchill DN, Thorpe KE, Nolph KD, Keshaviah PR, Oreopoulos DG, Page D: Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1998, 9(7):1285-1292.
• [10]Rumpsfeld M, McDonald SP, Johnson DW: Higher peritoneal transport status is associated with higher mortality and technique failure in the Australian and New Zealand peritoneal dialysis patient populations. J Am Soc Nephrol 2006, 17(1):271-278.
• [11]Brimble KS, Walker M, Margetts PJ, Kundhal KK, Rabbat CG: Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis. J Am Soc Nephrol 2006, 17(9):2591-2598.
• [12]Garcia-Lopez E, Lindholm B, Davies S: An update on peritoneal dialysis solutions. Nat Rev Nephrol 2012, 8(4):224-233.
• [13]Cho Y, Johnson DW, Badve SV, Craig JC, Strippoli GF, Wiggins KJ: The impact of neutral-pH peritoneal dialysates with reduced glucose degradation products on clinical outcomes in peritoneal dialysis patients. Kidney Int 2013, 84(5):969-979.
• [14]Cho Y, Badve SV, Hawley CM, Wiggins K, Johnson DW: Biocompatible peritoneal dialysis fluids: clinical outcomes. Int J Nephrol 2012, 2012:812609.
• [15]Haag-Weber M, Kramer R, Haake R, Islam MS, Prischl F, Haug U, Nabut JL, Deppisch R: Low-GDP fluid (Gambrosol trio) attenuates decline of residual renal function in PD patients: a prospective randomized study. Nephrol Dial Transplant 2010, 25(7):2288-2296.
• [16]Williams JD, Topley N, Craig KJ, Mackenzie RK, Pischetsrieder M, Lage C, Passlick-Deetjen J: The Euro-Balance Trial: the effect of a new biocompatible peritoneal dialysis fluid (balance) on the peritoneal membrane. Kidney Int 2004, 66(1):408-418.
• [17]Park SH, Do JY, Kim YH, Lee HY, Kim BS, Shin SK, Kim HC, Chang YK, Yang JO, Chung HC, Kim CD, Lee WK, Kim JY, Kim YL: Effects of neutral pH and low-glucose degradation product-containing peritoneal dialysis fluid on systemic markers of inflammation and endothelial dysfunction: a randomized controlled 1-year follow-up study. Nephrol Dial Transplant 2012, 27(3):1191-1199.
• [18]Margetts PJ, McMullin JP, Rabbat CG, Churchill DN: Peritoneal membrane transport and hypoalbuminemia: cause or effect? Perit Dial Int 2000, 20(1):14-18.
• [19]Heaf JG, Sarac S, Afzal S: A high peritoneal large pore fluid flux causes hypoalbuminaemia and is a risk factor for death in peritoneal dialysis patients. Nephrol Dial Transplant 2005, 20(10):2194-2201.
• [20]Wiggins KJ, McDonald SP, Brown FG, Rosman JB, Johnson DW: High membrane transport status on peritoneal dialysis is not associated with reduced survival following transfer to haemodialysis. Nephrol Dial Transplant 2007, 22(10):3005-3012.
• [21]Johnson DW, Hawley CM, McDonald SP, Brown FG, Rosman JB, Wiggins KJ, Bannister KM, Badve SV: Superior survival of high transporters treated with automated versus continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2010, 25(6):1973-1979.
• [22]Yang X, Fang W, Bargman JM, Oreopoulos DG: High peritoneal permeability is not associated with higher mortality or technique failure in patients on automated peritoneal dialysis. Perit Dial Int 2008, 28(1):82-92.
• [23]van Biesen W, Heimburger O, Krediet R, Rippe B, La Milia V, Covic A, Vanholder R: Evaluation of peritoneal membrane characteristics: clinical advice for prescription management by the ERBP working group. Nephrol Dial Transplant 2010, 25(7):2052-2062.