Dialysate cell population and cancer antigen 125 in stable continuous ambulatory peritoneal dialysis patients: Their relationship with transport parameters

Abstract

We investigated the total cell count and cell population of the overnight peritoneal dialysis effluent (PDE) by flow cytometry in 76 stable continuous ambulatory peritoneal dialysis (CAPD) patients. The mean percentage of mesothelial cells and macrophages was 4.4% and 57%, respectively. A higher percentage of dead cells among the mesothelial cells compared with other cell populations in the PDE was observed. Peritoneal transport properties were studied in every patient by determining the dialysate to plasma ratio of creatinine concentration (D/P) at the fourth hour of the peritoneal equilibration test, and the mass transfer area coefficient of creatinine (MTACCr) or glucose. Cancer antigen 125 (CA125), suggested as a bulk marker for the mesothelial mass in stable peritoneal dialysis patients, was determined in the PDE. No correlation was demonstrated between CA125 and the number of mesothelial cells, lymphocytes, or macrophages in the PDE. A significant correlation was observed between CA125 and different parameters of peritoneal transport (D/P and MTACCr). On the contrary, neither the history of peritonitis nor the duration of CAPD appeared to affect the CA125 concentration in the PDE. The lack of correlation between CA125 in the PDE and the duration of CAPD may be related to the early loss of peritoneal transport properties as a result of the use of hypertonic dialysate in the majority of our patients with small-volume CAPD (3 × 2 L daily exchange). Our findings suggest that CA125 may not necessarily correlate well with the number of mesothelial cells in PDE. In patients with vanishing of the mesothelial layer, the measurement of CA125 (as a bulk marker for the mesothelial mass in the peritoneum) may reflect the change of peritoneal transport properties.