Peritoneal dialysis and loss of proteins: A review

Dulaney, John T.; Hatch, Fred E.

doi:10.1038/ki.1984.167

Cited by 141 publications

(82 citation statements)

References 72 publications

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“…In comparison, a fast peritoneal transport rate proportional to an increased small-pore area might be less influenced by capillary vasodilatation as a result of inflammation (28). Indeed, the relationship between large-pore transport (measured as JvL or PrC) and CRP, rather than small-pore transport and CRP has been suggested (4,5).…”

Section: Discussionmentioning

confidence: 99%

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Peritoneal Protein Leakage, Systemic Inflammation, and Peritonitis Risk in Patients on Peritoneal Dialysis

et al. 2012

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♦ Background: Whether peritoneal protein leakage predicts risk for peritonitis in patients on peritoneal dialysis (PD) is unknown. In this observational cohort study, we aimed to determine that association and, further, to explore if it might be explained by systemic inflammation. ♦ Methods: We prospectively followed 305 incident PD patients to first-episode peritonitis, censoring, or the end of the study. Demographics, comorbidity score, biochemistry, and peritoneal protein clearance (PrC) were collected at baseline. The predictors of first-episode peritonitis were analyzed prospectively. ♦ Results: During follow-up, 14 868 patient months and 251 episodes of peritonitis were observed. The baseline PrC was 73.2 mL/day (range: 53.2 -102 mL/day). Patients with a high PrC were prone to be older and malnourished. They also had a higher comorbidity score and higher Creactive protein values. In 132 first episodes of peritonitis, baseline PrC was shown to be a significant independent predictor after adjustment for age, sex, body mass index, diabetes, residual renal function, hemoglobin, and peritoneal transport rate. Systemic inflammatory markers such as serum albumin, C-reactive protein, and interleukin-6 could not explain the association of PrC and high risk for peritonitis. ♦ Conclusions: Baseline peritoneal protein leakage was able to independently predict risk for peritonitis, which is not explained by systemic inflammation. The underlying mechanisms should be explored in future.

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Section: Discussionmentioning

confidence: 99%

“…The PrC is viewed as a surrogate marker of large-pore transport, which is potentially a result of inflammation (4,18,27,28). In comparison, a fast peritoneal transport rate proportional to an increased small-pore area might be less influenced by capillary vasodilatation as a result of inflammation (28).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Protein Leakage, Systemic Inflammation, and Peritonitis Risk in Patients on Peritoneal Dialysis

et al. 2012

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“…This postulate emerged from work with other bacterial pathogens (16) as well as studies demonstrating that some differentially expressed B. burgdorferi proteins are temperature-regulated (5,17), whereas others appear to be modulated by undefined signaling molecules in blood (8). We further speculated that the necessary soluble factors would efficiently traverse both the peritoneum, which is known to be highly permeable to macromolecules (54,55), as well as the comparatively small pores in the dialysis membrane used to contain the spirochetes. With other bacterial pathogens, it has been shown that many of the signals which govern the expression of virulence determinants are small chemicals or com- or in vitro (lane 2) were amplified by PCR using primer sets specific for 2.9-7lpA/B, ospA, and fla. 10 l from each amplification reaction was subjected to agarose gel electrophoresis and stained with ethidium bromide.…”

Section: Discussionmentioning

confidence: 99%

A new animal model for studying Lyme disease spirochetes in a mammalian host-adapted state.

et al. 1998

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There is now substantial evidence that Borrelia burgdorferi , the Lyme disease spirochete, undergoes major alterations in antigenic composition as it cycles between its arthropod and mammalian hosts. In this report, we cultivated B. burgdorferi 297 within dialysis membrane chambers implanted into the peritoneal cavities of rats to induce antigenic changes similar to those which occur during mammalian infection. Chamber-grown spirochetes, which remained fully virulent, did not express either outer surface protein A or Lp6.6, lipoproteins known to be downregulated after mammalian infection. However, they did, express p21, a well characterized outer surface protein E homologue, which is selectively expressed during infection. SDS-PAGE, two-dimensional gel electrophoresis, and immunoblot analysis revealed that chamber-grown borreliae also expressed uncharacterized proteins not expressed by in vitro-cultivated spirochetes; reactivity with sera from mice chronically infected with B. burgdorferi 297 confirmed that many of these novel proteins are selectively expressed during experimental murine infection. Finally, we used differential display RT-PCR to identify transcripts of other differentially expressed B. burgdorferi genes. One gene ( 2.9-7lpB ) identified with this technique belongs to a family of genes located on homologous 32-and 18-kb circular plasmids. The lipoprotein encoded by 2.9-7lpB was shown to be selectively expressed by chambergrown spirochetes and by spirochetes during experimental infection. Cultivation of B. burgdorferi in rat peritoneal implants represents a novel system for studying Lyme disease spirochetes in a mammalian host-adapted state. ( J. Clin. Invest. 1998. 101:2240-2250.) Key words: host-adapted • chamber implants • ticks • Borrelia burgdorferi • outer surface protein

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“…total protein in serum was not available, an estimation of total protein was done from albumin. However, it should be noted that total protein in dialysate originates not only from the plasma but also from local production of proteins and peptides by peritoneal tissues or cells also contribute (33). Patients with high comorbidity may have high secretion rates of the above-mentioned proteins and thereby a higher total protein clearance than that for albumin.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Albumin and Protein Losses Do Not Predict Outcome in Peritoneal Dialysis Patients

Balafa

Halbesma²,

Struijk³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Peritoneal clearance of albumin-unlike the transport of small molecules-is defined by both vascular surface area and size-selective permeability. Few studies have supported a positive correlation between peritoneal albumin loss and mortality. The aim of this study was to investigate whether baseline peritoneal loss and clearance of albumin and other proteins is a risk factor of death in peritoneal dialysis patients.Design, setting, participants, & measurements All incident peritoneal dialysis patients in our center during the last 15 years were included. Mass-transfer area coefficient of creatinine and peritoneal clearances of albumin, ␤ 2 -microglobulin, ␣ 2 -macroglobulin, and immunoglobulin G were calculated during a standard peritoneal permeability analysis. The total amount of albumin loss in the dialysate was also calculated. Overall mortality was studied with an intention-to-treat analysis.Results Two hundred fifty-seven patients were included. High baseline albumin clearance was associated with fast transport status, the presence of peripheral arterial disease, and a high comorbidity index, whereas C-reactive protein levels did not differ from the patients with low albumin clearance. Age, high comorbidity score, C-reactive protein levels Ͼ10 mg/L, and a low serum albumin were associated with mortality. Peritoneal albumin clearances and albumin loss were not associated with death in crude and adjusted analysis. Similarly, peritoneal clearances of immunoglobulin G, ␣ 2 -macroglobulin, and ␤ 2 -microglobulin were not determinants of survival. ConclusionsBaseline peritoneal albumin and protein clearances are associated with signs of comorbidity, but this does not have a measurable effect on patient survival.

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Peritoneal dialysis and loss of proteins: A review

Cited by 141 publications

References 72 publications

Peritoneal Protein Leakage, Systemic Inflammation, and Peritonitis Risk in Patients on Peritoneal Dialysis

Peritoneal Protein Leakage, Systemic Inflammation, and Peritonitis Risk in Patients on Peritoneal Dialysis

A new animal model for studying Lyme disease spirochetes in a mammalian host-adapted state.

Peritoneal Albumin and Protein Losses Do Not Predict Outcome in Peritoneal Dialysis Patients

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