Diagnostic and prognostic role of peritoneal CA 125 in peritoneal dialysis patients presenting with acute peritonitis

Abstract

BackgroundCancer antigen 125 (CA125) is made by peritoneal mesothelial cells and can be measured in spent dialysate effluent from peritoneal dialysis (PD) patients. It has been suggested that CA125 is a marker of peritoneal mesothelial cell mass and turnover. As PD CA125 increases during peritoneal inflammation, we wished to determine whether measuring PD CA125 during peritonitis provided additional information in determining outcome of peritonitis.MethodsWe prospectively measured peritoneal CA125 in 127 adult PD patients presenting with 187 acute episodes of PD peritonitis, measuring peritoneal CA125 from a sample of dialysate effluent obtained from a 4 hour 2 litre 13.6 g/l dextrose peritoneal dwell.ResultsMean patient age 60.8 ± 17.1 years, 62.6% male, 33.7% diabetic and the median PD vintage was 22 (11-48) months. 127 patients (66.8%) presented with their first episode of peritonitis, 20% their second episode, 13.2% third or greater. Gram positive bacteria accounted for 64.7% of all peritonitis episodes and Gram negative bacteria 21.1%. Treatment was successful for 151 episodes of PD peritonitis (81.1%). The median PD effluent total WBC was 1240 (430-3660) /ml and serum CRP 67 (20-144) mg/l, with a PD CA125 of 38 (20.3-72.3) IU/l on presentation. There were positive correlations between PD effluent CA125 concentrations and total WBC on presentation (r = 0.41, p = <0.001) and dialysis vintage (r = -0.43, p < 0.001) but not with patient age, diabetic status, or serum CRP.There was no difference in PD effluent CA125 concentrations between Gram positive, and Gram negative peritonitis or between those episodes which responded to treatment, median 38 IU/ml (21-69) vs those with treatment failures 38 IU/ml (15-94).ConclusionWe did not find any additional diagnostic or prognostic benefit for measuring effluent CA125 in PD patients presenting with acute peritonitis compared to standard investigations, including peritoneal WBC and serum CRP. As such our study would not support the routine measurement of peritoneal CA125 during episodes of peritonitis.

High Intraperitoneal Interleukin-6 Levels Predict Peritonitis in Peritoneal Dialysis Patients: A Prospective Cohort Study

“…A previous study has indicated the potential use of effluent IL-6 and CA125 for an early diagnosis of encapsulating peritoneal sclerosis [29]. However, Panorchan and Davenport [30] found that it had no additional diagnostic or prognostic benefit for measuring effluent CA125 in PD patients presenting with acute peritonitis compared to standard investigations, including peritoneal WBC and serum CRP. Similarly, our study also found that the CA125 level in PDF was not an independent predictive factor for peritonitis in stable CAPD patients.…”

Cancer antigen 125 concentrations in patients on chronic peritoneal dialysis: Relationship with dialysis quality and membrane transport properties

“…No differences in peritoneal dCA-125 concentrations were found in patients with Gram-positive, Gram-negative, fungal and polymicrobial peritonitis, nor in patients who responded successfully to intraperitoneal antibiotics and those with treatment failure [30]. No correlation was observed between dCA-125 levels and the number of peritonitis episodes, accumulated days of peritoneal inflammation and ultrafiltration capacity [31]. However, in a patient with five episodes of peritonitis, ultrafiltration failure was diagnosed; this was preceded by a gradual and marked decline in CA-125 levels during a 3-year follow-up [32,33].…”

The Risk of Ovarian Malignancy Algorithm (ROMA) as a Predictive Marker of Peritoneal Dissemination in Epithelial Ovarian Cancer Patients

“…Therefore, the menopausal status should be carefully considered when analyzing serum markers because the ranges of their levels vary between pre- and postmenopausal patients. CA125 is influenced by several factors such as menopause, endometriosis, peritonitis, and pregnancy [17,18,19]. Therefore, CA125 might not be useful in the diagnostics of adnexal masses in premenopausal patients [20].…”