Appearance of tumor necrosis factor-α and soluble TNF-receptors I and II in peritoneal effluent of CAPD

Abstract

Dialysate and serum concentrations of tumor necrosis factor-alpha (TNF-alpha), soluble TNF-receptor I (sTNFRI) and soluble TNF-receptor II (sTNFRII) were measured during stable and infectious CAPD to determine whether these mediators are released intraperitoneally or derived from the circulation. Dialysate/serum ratios were compared to those of various marker proteins for peritoneal transport and to interleukin-6 (IL-6), which is locally produced. Peritoneal immunoreactive TNF-alpha could be detected in 19 of 20 stable CAPD patients after a night dwell, but only occasionally and in lower concentrations during and after a standard four-hour peritoneal permeability test. Both sTNFRs highly exceeded TNF-alpha dialysate concentrations. In case of peritonitis a median 16-fold increase in dialysate TNF-alpha occurred on the first day, which declined towards control values during a longitudinal follow-up of eight consecutive days. sTNFRI and sTNFRII in dialysate increased three- to fourfold. Their peaks, however, appeared on the second peritonitis day. Bioactive TNF-alpha was only detected when immunoreactive levels exceeded 1000 pg/ml. Serum values of all variables were not altered during infection; sTNFRs exceeded TNF-alpha 300- to 400-fold. During stable CAPD indirect evidence was obtained for transperitoneal transport from plasma to dialysate of TNF-alpha (molecular wt 17 kD), sTNFRI (55 kD) and sTNFRII (75 kD). Dialysate/serum (D/S) ratios were higher, the lower the molecular weight; they were related to D/S ratios of those marker proteins with the nearest molecular weight; D/S ratios were unrelated to the intraperitoneally produced IL-6. Furthermore, the observed D/S ratios were as expected theoretically for their molecular weights.(ABSTRACT TRUNCATED AT 250 WORDS)

Peritoneal Dialysis Reduces the Number of Hospitalization Days in Heart Failure Patients Refractory to Diuretics

“…Although the exact reason for this improvement remains uncertain, correction of fluid overload with peritoneal ultrafiltration has been suggested to play a role in pushing the patient's hemodynamic status to the left on the Frank-Starling curve. Peritoneal clearance of proinflammatory cytokines (for example, tumor necrosis factor α, interleukin 1, and interleukin 6-all described as potential myocardial depressant factors) is another mechanism by which PD might lead to improvement in LVEF (32).…”

Can Effluent Matrix Metalloproteinase 2 and Plasminogen Activator Inhibitor 1 be Used as Biomarkers of Peritoneal Membrane Alterations in Peritoneal Dialysis Patients?

“…By interpolation of the molecular weights of MMP-2 and PAI-1 in the regression equation, the expected D/P for each of those molecules was calculated. The concentrations of MMP-2 and PAI-1 attributed to local production were defined as the difference between the measured and the predicted dialysate concentration (21,22).…”

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

“…One reason for the increase in EF is thought to be the removal of cardio depressant agents by PD (66). In many of these studies, the exercise capacities of HF patients were assessed by the NYHA classification and the results shows that NHYA class regresses and EF increases with PUF (58,(67)(68)(69)(70)(71)(72)(73).…”