Pro-inflammatory cytokines: a possible relationship with dialytic adequacy and serum albumin in peritoneal dialysis patients

The main reason why peritoneal dialysis (PD) still has limited use in the management of patients with end-stage renal disease (ESRD) lies in the fact that the currently used glucose-based PD solutions are not completely biocompatible and determine, over time, the degeneration of the peritoneal membrane (PM) and consequent loss of ultrafiltration (UF). Here we evaluated the biocompatibility of a novel formulation of dialytic solutions, in which a substantial amount of glucose is replaced by two osmometabolic agents, xylitol and l-carnitine. The effect of this novel formulation on cell viability, the integrity of the mesothelial barrier and secretion of pro-inflammatory cytokines was evaluated on human mesothelial cells grown on cell culture inserts and exposed to the PD solution only at the apical side, mimicking the condition of a PD dwell. The results were compared to those obtained after exposure to a panel of dialytic solutions commonly used in clinical practice. We report here compelling evidence that this novel formulation shows better performance in terms of higher cell viability, better preservation of the integrity of the mesothelial layer and reduced release of pro-inflammatory cytokines. This new formulation could represent a step forward towards obtaining PD solutions with high biocompatibility.

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Serum albumin and von Willebrand factor: possible markers for early detection of vascular damage in children undergoing peritoneal dialysis

Clinical & Investigative Medicine ◽

10.25011/cim.v39i4.27090 ◽

2016 ◽

Vol 39 (4) ◽

pp. 111 ◽

Cited By ~ 4

Author(s):

Nuran Cetın ◽

Nadide M Sav ◽

Duran Karabel ◽

Ali Yildirim ◽

Bilal Yıldız

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Early Detection ◽

Serum Albumin ◽

Von Willebrand Factor ◽

Independent Predictor ◽

Left Ventricular ◽

Dialysis Patients ◽

Von Willebrand ◽

Willebrand Factor

Purpose: Cardiovascular diseases are the main causes of morbidity and mortality in children with end-stage renal disease and the relationships among several relevant potential biomarkers were investigated in pediatric peritoneal dialysis patients. Methods: Serum homocysteine, von Willebrand factor (vWF), apolipoproteins A and B, lipoprotein-a, high sensitive-CRP, hemoglobin, phosphorus and parathyroid hormone (PTH) levels, systolic (SBP) and diastolic (DBP) blood pressure, carotid intima-media thickness (cIMT) and left ventricular mass index (LVMI) were measured in 21 pediatric peritoneal dialysis patients and control subjects. Results: All risk factors were higher in patients than controls. LVMI values were negatively correlated with hemoglobin and positively correlated with PTH and phosphorus levels (p=0.007, r= - 0.573; p=0.013, r= 0.532 and p=0.035, r= 0.461, respectively). cIMT was negatively associated with serum albumin and positively correlated with vWF levels and with SBP and DBP (p=0.006, r= - 0.578; p=0.039, r= 0.453; p=0.02, r= 0.503; p=0.024, r= 0.491, respectively). Robust regression analyses showed that hemoglobin was an independent predictor of LVMI and serum albumin was an independent predictor of cIMT. Conclusion: Only uremia-related factors were independent risk factors for predicting LVMI and cIMT. Hemoglobin level may be a critical factor in the development of left ventricular hypertrophy; therefore, effective treatment of anemia is crucial. Low serum albumin and high hsCRP and vWF levels, and their correlations with cIMT, indicate these patients could be at risk of developing malnutrition–inflammation–atherosclerosis syndrome and suggest that serum albumin and vWF levels may be useful markers for early detection of vascular damage.

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Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

Peritoneal Dialysis International ◽

10.1177/089686080202200312 ◽

2002 ◽

Vol 22 (3) ◽

pp. 371-379 ◽

Cited By ~ 45

Author(s):

◽

Michael V. Rocco ◽

Diane L. Frankenfield ◽

Barbara Prowant ◽

Pamela Frederick ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Renal Function ◽

Peritoneal Dialysis ◽

Serum Albumin ◽

Creatinine Clearance ◽

Residual Renal Function ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

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Abnormalities in Glucose Metabolism, Appetite-Related Peptide Release, and Pro-inflammatory Cytokines Play a Central Role in Appetite Disorders in Peritoneal Dialysis

Frontiers in Physiology ◽

10.3389/fphys.2019.00630 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 1

Author(s):

Lorena Avila-Carrasco ◽

Mario A. Pavone ◽

Elena González ◽

Álvaro Aguilera-Baca ◽

Rafael Selgas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Glucose Metabolism ◽

Inflammatory Cytokines ◽

Related Peptide ◽

Peptide Release ◽

Pro Inflammatory Cytokines

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Serum Albumin: A Predictor of Long-term Outcome in Peritoneal Dialysis Patients

American Journal of Kidney Diseases ◽

10.1016/s0272-6386(12)80985-1 ◽

1994 ◽

Vol 23 (2) ◽

pp. 283-285 ◽

Cited By ~ 55

Author(s):

David M. Spiegel ◽

Julia A. Breyer

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Dialysis Patients ◽

Term Outcome ◽

Long Term Outcome

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Serum Albumin: A Marker for Morbidity in Peritoneal Dialysis Patients

American Journal of Kidney Diseases ◽

10.1016/s0272-6386(12)80716-5 ◽

1993 ◽

Vol 21 (1) ◽

pp. 26-30 ◽

Cited By ~ 57

Author(s):

David M. Spiegel ◽

Michelle Anderson ◽

Urakay Campbell ◽

Kim Hall ◽

Gaye Kelly ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Dialysis Patients

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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.

Journal of the American Society of Nephrology ◽

10.1681/asn.v971285 ◽

1998 ◽

Vol 9 (7) ◽

pp. 1285-1292 ◽

Cited By ~ 10

Author(s):

D N Churchill ◽

K E Thorpe ◽

K D Nolph ◽

P R Keshaviah ◽

D G Oreopoulos ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Membrane Transport ◽

Patient Survival ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Technique Survival ◽

Survival Probabilities ◽

The Mean ◽

Technique Failure

The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-yr patient survival probabilities were 91, 80, 72, and 71% for L, LA, HA, and H, respectively (P = 0.11). The 2-yr probabilities of both patient and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique failure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.33, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the mean 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and H, respectively (P < 0.001). The mean serum albumin values (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HA, and H, respectively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death. The decreased drain volume, increased albumin loss, and decreased serum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be considered in H and HA transporters.

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Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease.

Journal of the American Society of Nephrology ◽

10.1681/asn.v75728 ◽

1996 ◽

Vol 7 (5) ◽

pp. 728-736 ◽

Cited By ~ 3

Author(s):

R N Foley ◽

P S Parfrey ◽

J D Harnett ◽

G M Kent ◽

D C Murray ◽

...

Keyword(s):

Heart Disease ◽

Peritoneal Dialysis ◽

Ischemic Heart Disease ◽

Serum Albumin ◽

Cardiac Failure ◽

Serum Albumin Level ◽

De Novo ◽

Albumin Level ◽

Dialysis Patients ◽

Overall Mortality

A cohort of 432 ESRD (261 hemodialysis and 171 peritoneal dialysis) patients was followed up prospectively for an average of 41 months. Baseline and annual demographic, clinical, and echocardiographic assessments were performed, as well as serial clinical and laboratory tests measured monthly while patients were on dialysis therapy. Among hemodialysis patients, after adjustment was made for age, diabetes, and ischemic heart disease, as well as hemoglobin and blood pressure levels measured serially, a 10-g/L fall in mean serum albumin level was independently associated with the the development of de novo (relative risk [RR], 2.22; P = 0.001) and recurrent cardiac failure (RR, 3.84; P = 0.003), de novo (RR, 5.29; P = 0.001) and recurrent ischemic heart disease (RR, 4.24; P = 0.005), cardiac mortality (RR, 5.60; P = 0.001), and overall mortality (RR, 4.33; P < 0.001). Among peritoneal dialysis patients, a 10-g/L fall in mean serum albumin level was independently associated with the progression of left ventricular dilation as seen on follow-up echocardiography (beta, 13.4 mL/m2; P = 0.014), the development of de novo cardiac failure (RR, 4.16; P = 0.003), and overall mortality (RR, 2.06; P < 0.001). Hypoalbuminemia, a major adverse prognostic factor in dialysis patients, is strongly associated with cardiac disease.

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P1130A CELLULAR MODEL OF HUMAN MESOTHELIUM TO STUDY OF WATER TRANSPORT DURING PERITONEAL DIALYSIS AND THE BIOCOMPATIBILITY OF INNOVATIVE GLUCOSE-SPARING SOLUTIONS.

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa144.p1130 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Francesca Piccapane ◽

Rosa Caroppo ◽

Arduino Arduini ◽

Roberto Corciulo ◽

Roberto Russo ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Water Transport ◽

Inflammatory Cytokines ◽

Glucose Concentration ◽

Water Channel ◽

Mesothelial Cells ◽

Dependent Manner ◽

Endogenous Expression ◽

Apical Side ◽

Pro Inflammatory Cytokines

Abstract Background and Aims The three pore model postulates that the endothelium of peritoneal capillaries is the major limiting barrier regulating water transport across peritoneal membrane during peritoneal dialysis (PD). We hypothesize that the mesothelium may represent an additional selective barrier to water diffusion in PD. We previously demonstrated that the water channel AQP1 is expressed in vivo by mesothelial cells. Here, we characterized an immortalized cell line of human mesothelium (HMC) to study the functional role of the water channel AQP1 in mediating water transport during PD and also to test the biocompatibility of glucose-sparing PD solutions (Xylocore), containing xylitol and L-carnitine as the main osmotic agents. Method Cells were grown onto porous cell culture inserts to achieve polarization. Polarization was demonstrated by expression of the tight junction markers Zo-1 and occludin. Transepithelial water transport was measured by TEA+-sensitive microelectrodes. HMC cell monolayers were exposed to PD solutions at the apical side for 8 hours. The biocompatibility of conventional versus innovative PD solutions was evaluated by MTT-test, measurement of transepithelial electrical resistance (TEER) and production of pro-inflammatory cytokines by by Luminex xMAP technology. Results HMC cells showed polarized expression of Na+/K+-ATPase and tight junctions markers but no endogenous expression of AQP1. HMC showed a low TEER (40Ω/cm2) compared to renal cells not expressing AQP1(1000Ω/cm2). However, the transepithelial water transport was comparable between the two cell types. Experiments in HMCs transfected with AQP1 cDNA, suggested that the water permeability of HMC was increased by two-fold in the presence of AQP1. Biocompatibility assays indicated that in conventional dialysis solutions glucose concentration decreased cell viability in a dose-dependent manner. Glucose concentration also strongly decreased the TEER, suggesting reduction of the barrier integrity, and increased pro-inflammatory cytokines production. Interestingly, substitution of part of the glucose with xylitol and L-carnitine minimized these effects. Conclusion These results suggest that the mesothelium may represent an additional selective barrier regulating water transport through the water channel AQP1 in PD. Importantly, we also demonstrate that the formulation of glucose-sparing PD solutions containing xylitol and L-carnitine better preserve mesothelial cells viability and may represent a useful means to prolong the dialysis life of patients undergoing peritoneal dialysis.

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