Abstract
PurposeSystemic and intraperitoneal inflammation are characteristic features of patients with end-stage renal disease undergoing chronic peritoneal dialysis (PD). Arginine vasopressin (AVP) and its surrogate marker copeptin play important roles in many pathophysiological processes in chronic kidney disease. The aim of this study was to assess if copeptin concentrations in plasma and dialysate were related to peritoneal transport parameters and residual renal function (RRF) in incident PD patients.MethodsIn 37 clinically stable incident PD patients (mean age 50 years, 68% women, 32% diabetes), a 4 h peritoneal equilibration test (PET) was performed 4–6 weeks after the onset of PD. Plasma (at 2 h of PET) and dialysate (at 4 h) concentrations of copeptin, high-sensitivity C-reactive protein and interleukin-6 (IL-6) were determined.ResultsPlasma (80.7 ± 37.3 pg/mL) and dialysate (33.2 ± 18.0 pg/mL) concentrations of copeptin were correlated (Rs = 0.52, p = 0.001). Plasma and dialysate copeptin concentrations were negatively correlated with renal function as assessed by renal Kt/V (Rs = − 0.38; p = 0.021 and Rs = − 0.33; p = 0.047, respectively). At PET, dialysate copeptin negatively correlated with D/P creatinine (Rs = − 0.35, p = 0.033), and positively with D/D0 glucose (Rs = 0.33, p = 0.045) and ultrafiltration (Rs = 0.37, p = 0.024). Multivariate analysis showed that low dialysate copeptin (β = –0.30, p = 0.049) and high dialysate IL-6 (β = + 0.40, p = 0.012) were independent determinants of higher D/P creatinine.ConclusionsDialysate copeptin was negatively associated with D/P creatinine in incident PD patients suggesting a potential influence of copeptin or AVP on peritoneal solute transport rate that might involve vasoactive mechanisms.
Highlights
Chronic kidney disease (CKD) affects millions of people worldwide and end-stage renal disease (ESRD) patients have a high risk of premature cardiovascular death
Since univariate analysis showed that copeptin and IL-6 dialysate concentrations were most strongly associated with D/P creatinine, multivariate analysis was performed with D/P creatinine as dependent variable and dialysate copeptin and logarithmically transformed dialysate IL-6 concentration as independent variables
Our study is the first to report that dialysate copeptin, a surrogate marker for arginine vasopressin (AVP), is associated with peritoneal transport assessed by peritoneal equilibration test (PET) in peritoneal dialysis (PD) patients who were investigated 4–6 weeks following initiation of PD therapy
Summary
Chronic kidney disease (CKD) affects millions of people worldwide and end-stage renal disease (ESRD) patients have a high risk of premature cardiovascular death. Apart from traditional risk factors such as high age, smoking, hypertension and/or diabetes, the presence of persistent low-grade systemic inflammation with increased concentration of pro-inflammatory cytokines has been acknowledged as an important underlying mechanism of cardiovascular disease in ESRD [1,2,3,4]. Local peritoneal inflammation has been linked to higher peritoneal solute transport rate (PSTR) as assessed by dialysate/plasma (D/P) ratio of creatinine in peritoneal equilibration test (PET) [7]. There is an ongoing search for biomarkers associated with peritoneal transport rate; so far, the dialysate concentration of interleukin-6 (IL-6) has been found to be strongly related to D/P ratio of creatinine [2, 8]. High circulating concentrations of copeptin have been linked to a decline in glomerular filtration rate (GFR) and greater risk of new-onset CKD [12]. It is not known to what extent copeptin and AVP may influence peritoneal transport
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