Serum CA-125 Level in End-Stage Renal Disease Patients Maintained on Chronic Peritoneal Dialysis or Hemodialysis: The Effect of Continuous Presence of Peritoneal Fluid, Peritonitis, and Peritoneal Catheter Implantation

Abstract

Serum CA-12 5 an ovarian tumor marker, is used to screen and follow up patients with ovarian cancer. Normal values ( < 35 U/ml) have been reported in patients with end-stage renal disease and patients maintained on chronic hemodialysis (HD). Non-malignant ascites has been associated with high serum levels of CA-125, suggesting that the presence of fluid in the peritoneal cavity may stimulate its release. We studied 38 HD and 43 chronic ambulatory peritoneal dialysis (CAPD) patients with regard to serum CA-125 levels. In the HD patients, the mean ± SE serum CA-125 level was 10.1 ± 1.7 U/ml (range < 5-39) with 8% of the patients having serum levels of > 35 U/ml. In the CAPD patients, the mean serum CA-125 level in all samples collected (n = 68) was 17.7 ± 2.7 U/ml (range < 5-101, p < 0.01 vs. HD) with 16% of the sera showing levels of > 35 U/ml. The high serum CA-125 levels in the CAPD patients were from sera obtained within 2 months of diagnosis of peritonitis, peritoneal dialysis (PD) catheter implantation, or intra-abdominal surgery. When serum samples from this 2-month period were excluded, the mean serum CA-125 level was 8.9 ± 1.5 U/ml (p = NS vs. HD) and only 1 patient had an abnormal level. Peritoneal dialysate CA-125 levels during an episode of peritonitis were significantly higher than at the baseline (69.1 ± 14.2 vs. 21 ± 2.5, p = 0.004) and both were significantly higher than the serum levels (p < 0.0001). Serum CA-125 levels were also the same in both sexes and races. In conclusion, it was found that while the serum CA-125 level is within normal limits in the majority of HD and stable CAPD patients, it is not uncommon that it is elevated in CAPD patients within 2 months of peritonitis, PD catheter placement, or intra-abdominal surgery, particularly when peritoneal exchanges are temporarily on hold in the latter two. The serum CA-125 level should be interpreted with caution in the CAPD patients as it may be a non-specific marker of peritoneal irritation. It was also found that there was a significant removal of CA-125 by the peritoneal fluid which markedly increased during episodes of peritonitis.

Proteomic-based identification of haptoglobin-1 precursor as a novel circulating biomarker of ovarian cancer

“…Moreover, CA 125 concentrations are elevated in women with benign gynaecologic conditions, including ovarian cysts, endometriosis and uterine fibroids, which are part of the differential diagnosis for ovarian cancer (Mogensen, 1992;Cannistra, 1993;Mackey and Creasman, 1995). In some cases, women with hepatic disease, renal failure, pancreatitis or other conditions may have elevated CA 125 making the usefulness of CA 125 as a marker for early detection limited (Bastani and Chu, 1995;Devarbhavi et al, 2002). In recent years, several serum markers have been identified and explored as possible adjuncts to CA 125 screening.…”

Tuberculous peritonitis in a haemodialysis patient with elevated serum CA 125 and hypercalcaemia

“…CA 125 is not elevated in general haemodialysis patients (20), and serum CA 125 level is also normal in peritoneal dialysis (PD) patient (21). However, it is elevated in PD patients within 2 months of diagnosed peritonitis, PD catheter implantation or intra‐abdominal surgery (22). Moreover, dialysate CA 125 can be considered as a marker of mesothelial cell mass (21).…”

“…Moreover, dialysate CA 125 can be considered as a marker of mesothelial cell mass (21). A sudden decrease in dialysate CA 125 appearance rate may indicate the development of peritoneal sclerosis (22). Elevated serum CA 125 has been reported in patients with tuberculous peritonitis, and CA 125 normalised following 2–4 months of antituberculous treatment (5–8).…”

Strategies for revealing lower abundance proteins in two-dimensional protein maps

“…For example, the cancer specific antigen 125 (CA-125) is a serum marker for the diagnosis of ovarian cancer. CA-125 shows wide variation in sensitivity and specificity in the serum of ovarian cancer patient [70], yet high levels of this marker may be detected in ovarian cancer patient's ovarian venous drainage. Due to the multi-factorial genesis of cancer, it is likely that a combination of several markers will be required to effectively predict the biological behavior of a tumor.…”