Associations between the duration of dialysis, endotoxemia, monocyte chemoattractant protein-1, and the effects of a short-dwell exchange in patients requiring continuous ambulatory peritoneal dialysis.

Chia-Lin Wu,Der-Cherng Tarng,Hung-Hsiang Liou,Chirn-Bin Chang,Hung-Ming Wu,Ping-Fang Chiu,Chia-Chu Chang,Cordula M Stover

doi:10.1371/journal.pone.0109558

Abstract

BackgroundEndotoxemia is exaggerated and contributes to systemic inflammation and atherosclerosis in patients requiring continuous ambulatory peritoneal dialysis (CAPD). The risk of mortality is substantially increased in patients requiring CAPD for >2 years. However, little is known about the effects of long-term CAPD on circulating endotoxin and cytokine levels. Therefore, the present study evaluated the associations between plasma endotoxin levels, cytokine levels, and clinical parameters with the effects of a short-dwell exchange on endotoxemia and cytokine levels in patients on long-term CAPD.MethodsA total of 26 patients were enrolled and divided into two groups (short-term or long-term CAPD) according to the 2-year duration of CAPD. Plasma endotoxin and cytokine levels were measured before and after a short-dwell exchange (4-h dwell) during a peritoneal equilibration test (a standardized method to evaluate the solute transport function of peritoneal membrane). These data were analyzed to determine the relationship of circulating endotoxemia, cytokines and clinical characteristics between the two groups.ResultsPlasma endotoxin and monocyte chemotactic protein-1 (MCP-1) levels were significantly elevated in the long-term group. PD duration was significantly correlated with plasma endotoxin (r = 0.479, P = 0.016) and MCP-1 (r = 0.486, P = 0.012). PD duration was also independently associated with plasma MCP-1 levels in multivariate regression. Plasma MCP-1 levels tended to decrease (13.3% reduction, P = 0.077) though endotoxin levels did not decrease in the long-term PD group after the 4-h short-dwell exchange.ConclusionLong-term PD may result in exaggerated endotoxemia and elevated plasma MCP-1 levels. The duration of PD was significantly correlated with circulating endotoxin and MCP-1 levels, and was an independent predictor of plasma MCP-1 levels. Short-dwell exchange seemed to have favorable effects on circulating MCP-1 levels in patients on long-term PD.

Highlights

Peritoneal dialysis (PD) is a well-established treatment modality for patients with end-stage renal disease
The current study revealed that patients receiving continuous ambulatory peritoneal dialysis (CAPD) for . 24 months had higher plasma endotoxin and monocyte chemotactic protein-1 (MCP-1) levels than patients with a shorter PD duration
We found that the PD duration was independently associated with plasma MCP-1 levels

Summary

Introduction

Peritoneal dialysis (PD) is a well-established treatment modality for patients with end-stage renal disease. In Taiwan, about 6000 (10% of all patients undergoing dialysis) patients received PD in 2009 (Taiwan Renal Registry Data System, 2009) [1,2]. Beyond 2 years, PD was associated with greater risk of mortality compared with HD [4]. The long-term survival rate of patients undergoing PD is still poor (about 42% at 5 years) despite continued developments in modern medicine [6]. Endotoxemia is exaggerated and contributes to systemic inflammation and atherosclerosis in patients requiring continuous ambulatory peritoneal dialysis (CAPD). The present study evaluated the associations between plasma endotoxin levels, cytokine levels, and clinical parameters with the effects of a short-dwell exchange on endotoxemia and cytokine levels in patients on longterm CAPD

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Results

Discussion

Conclusion