Risk factor(s) related to high membrane permeability in peritoneal dialysis

Abstract

Aim: Peritoneal dialysis (PD) patients have different peritoneal membrane permeability (transport) characteristics. High peritoneal membrane permeability is associated with increased mortality risk in the patient population. In this study, we aimed to investigate possible risk factor(s) related to high peritoneal membrane permeability. Patients and method: The study included 475 PD patients (46.1 ± 14.5 years of mean age; 198 female and 277 male). The patients were divided two groups according to peritoneal equilibration test (PET) result: high-permeability group (high and highaverage) and low-permeability group (low-average and low). Results: In both the univariate and multivariate logistic regression analyses, it was found that diabetes mellitus and hypoalbuminemia was significantly associated with high peritoneal membrane permeability [relative risk (RR): 1.90, 95% confidence interval (CI): 1.26-2.86, p: 0.002 and RR: 2.14, 95% CI: 1.44-3.18, p50.001, respectively]. Conclusion: Diabetes mellitus and hypoalbuminemia were closely associated with high peritoneal membrane permeability. Diabetic patients had 1.9 times the likelihood of having high permeability. However, the relationship between hypoalbuminemia and high peritoneal permeability appears to be a result rather than cause. ARTICLE HISTORY

Comparison of peritoneal function within the first 1 year of peritoneal dialysis between diabetic and non‐diabetic patients

“…In the present study of 73 patients who started PD between 2011 and 2016, D/P Cr was significantly higher in diabetic than in non‐diabetic PD patients at the start of PD. Several reports have noted that diabetes was closely associated with higher peritoneal membrane permeability at the start of PD compared to non‐diabetic patients 11,12,28,29 . Additionally, important peritoneal histological changes including abnormalities of mesothelial cells or vascular walls occurred more frequently in diabetic ESRD patients before starting PD 9,10 .…”

“…These differences could contribute to the difference in peritoneal permeability indicated by D/P Cr. High peritoneal membrane permeability could cause higher peritoneal protein loss and trigger a lower serum albumin level 11 . Furthermore, high transporters usually have poor net ultrafiltration and potential systemic volume expansion.…”

“…Several reports have noted that diabetes was closely associated with higher peritoneal membrane permeability at the start of PD compared to non-diabetic patients. 11,12,28,29 Additionally, important peritoneal histological changes including abnormalities of mesothelial cells or vascular walls occurred more frequently in diabetic ESRD patients before starting PD. 9,10 Contreras-Velazquez et al 10 found that peritoneal histology before starting PD showed that diabetic patients had a higher mesothelial loss, higher mesothelial basement membrane thickening, higher proportion of vascular wall thickening/sclerosis, and higher proportion of inflammatory infiltrate than non-diabetic patients.…”

“…In 2015, Couchoud et al 8 published a systematic review, including 25 observational studies until February 2014, comparing mortality between 721 783 HD and 106 790 PD‐initiating patients with diabetes, and they concluded that evidence‐based arguments indicating that HD or PD as first RRT may improve outcomes in diabetics with ESRD were lacking. Diabetic PD patients were characterized as having hyperpermeability and structural deteriorations of the peritoneum even before the start of PD 9–12 . A higher peritoneal solute transport rate (PSTR), as shown by a higher dialysate to plasma ratio of creatinine (D/P Cr) obtained from a peritoneal equilibration test (PET), is associated with inflammation, hyperglycemia, and hypoalbuminemia and, furthermore, is an independent risk factor for patient or technical survival 12,13 .…”

“…Diabetic PD patients were characterized as having hyperpermeability and structural deteriorations of the peritoneum even before the start of PD. [9][10][11][12] A higher peritoneal solute transport rate (PSTR), as shown by a higher dialysate to plasma ratio of creatinine (D/P Cr) obtained from a peritoneal equilibration test (PET), is associated with inflammation, hyperglycemia, and hypoalbuminemia and, furthermore, is an independent risk factor for patient or technical survival. 12,13 Additionally, the presence of diabetes is thought to predict faster loss of residual renal function (RRF).…”