Relationship between peritoneal permeability with inflammation and subclinical atherosclerosis in peritoneal dialysis patients

Aim: High permeability in peritoneal dialysis (PD) is reported to be associated with increased mortality. Cardiovascular disease is the most important cause of morbidity and mortality in patients with end-stage renal disease. The inflammation is thought to take part in development of atherosclerosis. The aim of this study is to investigate the relation of peritoneal permeability type with carotid intima media thickness (CIMT) in PD patients.Material and Methods: Based on the standard peritoneal equilibration test, 56 PD patients (28 male) were divided in two transporter groups: low (low+low average) and high (high+high average) permeability. C-reactive protein (CRP) measured as a marker of inflammation and CIMT was evaluated by high-resolution B-mode ultrasonography.Results: Twenty one patients were low and 35 of them were high peritoneal transporters. Mean CRP level was significantly higher in the high permeability group (HPG) (1.62±1.7 vs 0.84±1 mg/dL; p=0.006). CIMT was higher in the HPG but this difference did not reach statistical significance (0.810±0.160 vs 0.740±0.160 mm; p=0.16).Conclusions: CRP, an indicator of inflammation, was found to be higher in the HPG. CIMT also was found to be higher in HPG although it was not statistically significant. One of the causes of increased mortality rate in this group of patients may be explained by inflammation and atherosclerosis.

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Pajek J, Kveder R, Bren A, Gucek A, Ihan A, Osredkar J, et al. Short-term effects of a new bicarbonate/lactate-buffered and conventional peritoneal dialysis fluid on peritoneal and systemic inflammation in CAPD patients: a randomized controlled study. Perit Dial Int 2008;28(1):44-52.
Bajo MA, Perez-Lozano ML, Albar-Vizcaino P, Del Peso G, Castro MJ, Gonzalez-Mateo G, et al. Low-GDP peritoneal dialysis fluid (‘balance’) has less impact in vitro and ex vivo on epithelial-to-mesenchymal transition (EMT) of mesothelial cells than a standard fluid. Nephrol Dial Transplant 2011;26(1):282-91.
Rippe B, Simonsen O, Heimburger O, Christensson A, Haraldsson B, Stelin G, et al. Long-term clinical effects of a peritoneal dialysis fluid with less glucose degradation products. Kidney Int 2001;59(1):348-57.
Wang T, Heimburger O, Cheng HH, Bergstrom J, Lindholm B. Does a high peritoneal transport rate reflect a state of chronic inflammation? Perit Dial Int 1999;19(1):17-22.
Breborowicz A, Oreopoulos DG. Evidence for the presence of chronic inflammation during peritoneal dialysis: Therapeutic implications. Perit Dial Int 1997;17 suppl 2:S37-41.
Kagan A, Bar Khayim Y. Role of peritoneal loss of albumin in the hypoalbuminemia of continuous ambulatory peritoneal dialysis patients: Relationship to peritoneal transport of solutes. Nephron 1995;71(3):314-20.
Harty JC, Boulton H, Venning MC, Gokal R. Is peritoneal permeability an adverse risk factor for malnutrition in CAPD patients? Miner Electrolyte Metab 1996;22(1-2):97-101.
Struijk DG, Krediet RT, Koomen GC, Boeschoten EW, Hoek FJ, Arisz L. A prospective study of peritoneal transport in CAPD patients. Kidney Int 1994;45(6):1739-44.
Fung L, Pollock CA, Caterson RJ, Mahony JF, Waugh DA, Macadam C, et al. Dialysis adequacy and nutrition determine prognosis in continuous ambulatory peritoneal dialysis patients. J Am Soc Nephrol 1996;7(5):737-44.
Han DS, Lee SW, Kang SW, Choi KH, Lee HY, Cho EY, et al. Factors affecting low values of serum albumin in CAPD patients. Adv Perit Dial 1996;12:288-92.
Mutluay R, Konca C, Erten Y, Pasaoglu H, Deger SM, Agirgun C, et al. Predictive markers of asymptomatic atherosclerosis in end-stage renal disease patients. Ren Fail 2010;32(4): 448-54.
Kim JK, Park S, Lee MJ, Song YR, Han SH, Kim SG, et al. Plasma levels of soluble receptor for advanced glycation end products (sRAGE) and proinflammatory ligand for RAGE (EN-RAGE) are associated with carotid atherosclerosis in patients with peritoneal dialysis. Atherosclerosis 2012;220(1):208-14.
Turkmen K, Tonbul HZ, Toker A, Gaipov A, Erdur FM, Cicekler H, et al. The relationship between oxidative stress, inflammation, and atherosclerosis in renal transplant and end-stage renal disease patients. Ren Fail 2012;34(10):1229-37.
Civilibal M, Caliskan S, Oflaz H, Sever L, Candan C, Canpolat N, et al. Traditional and ‘new’ CV risk markers and factors in pediatric dialysis patients. Pediatr Nephrol 2007;22:1021-9.
Bakkaloglu SA, Buyan N, Funahashi T, Pasaoglu H, Elhan AH, Hasanoglu E, et al. Adiponectin levels and atherosclerotic risk factors in pediatric chronic peritoneal dialysis patients. Perit Dial Int 2005;25(4):357-61.
Sylvestre LC, Fonseca KPD, Stinghen AEM, Pereira AM, Meneses RP, Pecoits-Filho R, et al. The malnutrition and inflammation axis in pediatric patients with chronic kidney disease. Pediatr Nephrol 2007;22(6):864-73.
Nascimento MM, Pecoits-Filho R, Qureshi AR, Hayashi SY, Manfro RC, Pachaly MA, et al. The prognostic impact of fluctuating levels of C-reactive protein in Brazilian haemodialysis patients: a prospective study. Nephrol Dial Transplant 2004;19(11):2803-9.
Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2002;106(1):100-5.
Litwin M, Trelewicz J, Wawer Z, Antoniewicz J, Wierzbicka A, Rajszys P, et al. Intima–media thickness and arterial elasticity in hypertensive children: controlled study. Pediatr Nephrol 2004;19(7):767-74.
Wang AY, Woo J, Lam CW, Wang M, Sea MM, Lui SF, et al. Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients? J Am Soc Nephrol 2003;14(7):1871-9.
Pecoits-Filho R, Stenvinkel P, Wang AY, Heimburger O, Lindholm B. Chronic inflammation in peritoneal dialysis: The search for the holy grail? Perit Dial Int 2004;24(4):327-39.
Wang AY. The John F. Maher Award Recipient Lecture 2006. The ‘‘heart of peritoneal dialysis’’: residual renal function. Perit Dial Int 2007;27(2):116-24.
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and CV disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107(3):499-511.
Devuyst O, Yool AJ. Aquaporin-1: new developments and perspectives for peritoneal dialysis. Perit Dial Int 2010;30(2):135-41.
Oh KH, Moon JY, Oh J, Kim SG, Hwang YH, Kim S, et al. Baseline peritoneal solute transport rate is not associated with markers of systemic inflammation or comorbidity in incident Korean peritoneal dialysis patients. Nephrol Dial Transplant 2008;23(7):2356-64.
Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45(10):1638-43.
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):271-8.
Welten AG, Schalkwijk CG, ter Wee PM, Meijer S, van den Born J, Beelen RJ. Single exposure of mesothelial cells to glucose degradation products (GDPs) yields early advanced glycation end-products (AGEs) and a proinflammatory response. Perit Dial Int 2003;23(3):213-21.
Stenvinkel P, Heimburger O, Jogestrand T. Elevated interleukin-6 predicts progressive carotid artery atherosclerosis in dialysis patients: association with chlamydia pneumonia seropositivity. Am J Kidney Dis 2002;39:274-82.
Craig RG, Kotanko P, Kamer AR, Levin NW. Periodontal diseases – a modifiable source of systemic inflammation for the end-stage renal disease patient on haemodialysis therapy? Nephrol Dial Transplant 2007;22(2):312-5.
Chung SH, Heimburger O, Stenvinkel P, Qureshi AR, Lindholm B. Association between residual renal function, inflammation and patient survival in new peritoneal dialysis patients. Nephrol Dial Transplant 2003;18(3):590-7.
Wang AY, Lam CW, Wang M, Woo J, Chan IH, Lui SF, et al. Circulating soluble vascular cell adhesion molecule 1: relationships with residual renal function, cardiac hypertrophy, and outcome of peritoneal dialysis patients. Am J Kidney Dis 2005;45(4):715-29.
Cohen G, Raupachova J, Hörl WH. The uraemic toxin phenylacetic acid contributes to inflammation by priming polymorphonuclear leucocytes. Nephrol Dial Transplant 2013;28(2):421-9.
Wang AY. Consequences of chronic inflammation in peritoneal dialysis. Semin Nephrol 2011;31(2):159-71.
Pecoits-Filho R, Lindholm B, Stenvinkel P. The malnutrition, inflammation, and atherosclerosis (MIA) syndrome–the heart of the matter. Nephrol Dial Transplant 2002;17(suppl 11):28-31.
Zoccali C. Traditional and emerging cardiovascular and renal risk factors: an epidemiologic perspective. Kidney Int 2006;70(1):26-33.
Johnston N, Dargie H, Jardine A. Diagnosis and treatment of coronary artery disease in patients with chronic kidney disease: Heart 2008;94(8):1080-8.