Hang Ying, Yan Hao, Zhang He, Li Zhenyuan, Fang Wei
Ying Hang, Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Hao Yan, Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pak J Med Sci. 2021 Jul-Aug;37(4):1104-1110. doi: 10.12669/pjms.37.4.4328.
We designed this prospective observational study to clarify the associations between dialysate IL-6, a marker of ongoing peritoneal inflammation, Tie2, an important factor in angiogenesis in the peritoneum, and a high peritoneal solute transport rate (PSTR) in patients undergoing peritoneal dialysis (PD) and to investigate their outcome predictive roles.
A total of 60 stable continuous ambulatory peritoneal dialysis (CAPD) patients from a single center in China were analyzed in this prospective study. We measured dialysate levels of IL-6 and Tie-2 using ELISAs. Our primary study endpoint was all-cause mortality with 10 years' follow-up.
For the evaluation of PSTR, we used the Dialysis/Plasma creatinine (D/Pcr) ratio. We subdivided the patients into two groups for statistical evaluation: low and low average D/Pcr (<0.64; L/A), and high and high average D/Pcr (≥0.65; H/A) transporters. The mean levels of dialysates IL-6 (21.71 ± 8.88 pg/mL) and Tie-2 (1.23 ± 0.43 ng/mL) were significantly higher in the H/A (high and high average, group than those in the L/A group (13.94 ± 5.43 pg/mL, p<0.001 and 0.95 ± 0.43 ng/mL, p=0.019; respectively). Moreover, IL-6 and Tie-2 were positively correlated with D/Pcr (r=0.366, p=0.004 and r=0.402, p=0.001; respectively). Both dialysates IL-6 and Tie-2 were independent determinants of a high peritoneal solute transport rate. After follow-up for 42.65±18.08 months, 30 patients (50.0%) had died. An increased D/Pcr increased the risk of all-cause mortality in patients with CAPD (p=0.018), but the dialysates IL-6 and Tie2 were not independent predictors of all-cause mortality (p>0.05).
Our results suggest that patients undergoing CAPD have a high peritoneal solute transport status with local peritoneal inflammation and angiogenesis. Increased D/Pcr is a relative risk factor for mortality and technique failure in patients undergoing CAPD.
我们设计了这项前瞻性观察性研究，以阐明腹膜透析（PD）患者中透析液白细胞介素-6（IL-6，持续性腹膜炎症的标志物）、Tie2（腹膜血管生成的重要因子）与高腹膜溶质转运率（PSTR）之间的关联，并研究它们对预后的预测作用。
本前瞻性研究分析了来自中国一个中心的60例稳定的持续性非卧床腹膜透析（CAPD）患者。我们使用酶联免疫吸附测定法（ELISA）测量透析液中IL-6和Tie-2的水平。我们的主要研究终点是10年随访期内的全因死亡率。
为评估PSTR，我们使用透析液/血浆肌酐（D/Pcr）比值。我们将患者分为两组进行统计学评估：低和低平均D/Pcr（<0.64；L/A）以及高和高平均D/Pcr（≥0.65；H/A）转运者。H/A组（高和高平均组）的透析液IL-6平均水平（21.71±8.88 pg/mL）和Tie-2平均水平（1.23±0.43 ng/mL）显著高于L/A组（13.94±5.43 pg/mL，p<0.001；0.95±0.43 ng/mL，p=0.019）。此外，IL-6和Tie-2与D/Pcr呈正相关（分别为r=0.366，p=0.004；r=0.402，p=0.001）。透析液IL-6和Tie-2均是高腹膜溶质转运率的独立决定因素。随访42.65±18.08个月后，30例患者（50.0%）死亡。D/Pcr升高增加了CAPD患者全因死亡的风险（p=0.018），但透析液IL-6和Tie2不是全因死亡的独立预测因素（p>0.05）。
我们的结果表明，接受CAPD治疗的患者存在高腹膜溶质转运状态，并伴有局部腹膜炎症和血管生成。D/Pcr升高是CAPD患者死亡和技术失败的一个相对危险因素。
