Intraperitoneal hyaluronan production in stable continuous ambulatory peritoneal dialysis patients

Abstract

Objective: Several cytokines and proteins are excreted intraperitoneally during the course of peritonitis and stable states in continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also regarded as a marker of peritoneal healing during bacterial peritonitis. We examined here, intraperitoneal HYA production in stable CAPD patients and compared the results to those of the peritoneal equilibration test (PET), the length of time on dialysis, and other marker proteins. Design: We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals. Setting: CAPD unit in Hitachi General Hospital. Patients: The subjects were 46 stable CAPD patients who underwent 104 PETs. Results: A correlation was found between the length of time on dialysis and the amount of HYA excretion in the 4-hr-dwell dialysate (r = 0.403, p < 0.001). A positive but weak correlation was found between the dialysate-to-plasma ratio of the creatinine concentration and dialysate HYA excretion (r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both the concentration of HYA (> 349.2 ng/mL) and the amount of HYA (> 743.6 μg/4-hr dwell). Five patients exceeded 1000 μg of HYA excretion in the 4-hr-dwell dialysate, 4 of whom showed an abrupt increase of HYA excretion to more than 1000 μg/4-hr dwell, and discontinued CAPD within 6 months due to ultrafiltration failure. Two of these 4 patients were diagnosed with sclerosing encapsulating peritonitis at autopsy. Conclusion: Intraperitoneal HYA production increased with both higher permeable membrane and the length of time on CAPD. Monitoring of HYA in the peritoneal dialysate may be useful as a marker to assess functional and morphological changes in the peritoneum in long-term CAPD patients.