Paricalcitol and Peritoneal Protein Loss in Peritoneal Dialysis: A Double-Center Study

Abstract

Background/Aims: Peritoneal protein loss (PPL) is associated with cardiovascular disease and mortality in peritoneal dialysis (PD). Controversial results have been published about the effect of paricalcitol in PPL among PD patients. This study intends to analyze the relationship between paricalcitol and PPL in PD. Methods: In a retrospective study, prevalent PD patients were divided into 2 groups: “with paricalcitol” and “without paricalcitol”. X²-test, Student’s t test, Pearson correlation coefficient and Logistic Regression analysis were applied. Results: Eighty-two patients were included. PPL was lower among patients medicated with paricalcitol (5.17 ± 1.71 vs. 6.79 ± 2.10 g/24 h, p = 0.0001). In multivariate analysis, paricalcitol and dialysate/plasma ratio of creatinine (D/P creatinine) were independently related to PPL (OR 4.270 [1.437–12.684], p = 0.009 and OR 0.205 [0.064–0.659], p = 0.008, respectively), adjusted for diabetes. Conclusion: Paricalcitol and D/P creatinine were independently related to PPL. Paricalcitol may have an effect on PPL in PD patients

Association of Lean Body Mass Index and Peritoneal Protein Clearance in Peritoneal Dialysis Patients

“…However, limited sample size and few associated factors considered in those studies might limit the implications. As proved in the current study with larger sample size, diabetes, higher D/P creatinine ratio, and lower residual renal creatinine clearance were independently associated with higher PPCl, which were consistent with some recent studies [4, 6, 8, 25-27]. These factors have been demonstrated as risk factors of increased mortality in PD population [28-31], which may partially explain the negative effects of higher PPCl on patients outcomes.…”

Peritoneal Protein Loss, Leakage or Clearance in Peritoneal Dialysis, Where do we Stand?

“…Sánchez-Álvarez et al showed no change in PPL when using paricalcitol supplementation, but there was no control group enrolled in this study (63). Other studies, with larger study populations and controls, demonstrated a reduction of PPL with paricalcitol supplementation (23,28).…”

“…The results of investigations showed that the key to diminish PPL is not related to dialysis prescription, as once thought (3,43,58,59), and possible alternatives may include ACEIs and vitamin D therapies (1,28). The study of new therapeutic options is warranted.…”

“…Measurement of PPL is challenging, due to low protein concentration (0.10 – 1.40 g/L), large sample-to-sample variation, and the presence of non-protein interfering substances, such as a high content of inorganic ions. Peritoneal protein loss has been measured by chemical (e.g., biuret and Folin-Lowry reactions) (27), turbidimetric (28), and dye-binding or colorimetric (pyrogallol red molybdate [29]) methods. Biuret test detection limit is enhanced with Folin-Ciocalteu reagent (Folin-Lowry method), resulting in a range of 0.01 – 1.0 mg/mL; the pyrogallol red molybdate method has a range of 0.01 – 2 mg/mL; turbidimetry presents detection limits of 0.002 – 0.01 mg/mL (30,31).…”

IL-17A as a Potential Therapeutic Target for Patients on Peritoneal Dialysis

“…Paricalcitol also exerted other beneficial effects, like attenuation of in vitro MMT through Smads modulation [ 286 ]; impairment of oxidative stress; and activation of the NLRP3 inflammasome, a multiprotein complex that promotes IL-1β and IL-18 maturation [ 287 ]. Interestingly, a recent retrospective study in prevalent PD patients observed lower peritoneal protein loss in patients treated with paricalcitol [ 288 ]. Thus, paricalcitol acts as an anti-inflammatory agent that might improve peritoneal alterations in PD by mechanisms that could involve IL-17A modulation ( Figure 4 ).…”