Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survival

Title
Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survival
Author(s)
도준영Mark Lambie[Mark Lambie]James Chess[James Chess]Kieron L. Donovan[Kieron L. Donovan]Yong Lim Kim[Yong Lim Kim]Hi Bahl Lee[Hi Bahl Lee]Hyunjin Noh[Hyunjin Noh]Paul F. Williams[Paul F. Williams]Andrew J. Williams[Andrew J. Williams]Sara Davison[Sara Davison]Marc Dorval[Marc Dorval]Angela Summers[Angela Summers]John D. Williams[John D. Williams]John Bankart[John Bankart]Simon J. Davies[Simon J. Davies]Nicholas Topley[Nicholas Topley]
Keywords
RESIDUAL RENAL-FUNCTION; NECROSIS-FACTOR-ALPHA; CANCER ANTIGEN 125; MEMBRANE-TRANSPORT; TECHNIQUE FAILURE; SOLUTE TRANSPORT; CARDIOVASCULAR MORTALITY; HEMODIALYSIS-PATIENTS; INTERLEUKIN-6 SYSTEM; FLUID TRANSPORT
Issue Date
201312
Publisher
AMER SOC NEPHROLOGY
Citation
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, v.24, no.12, pp.2071 - 2080
Abstract
Systemic inflammation, as evidenced by elevated inflammatory cytokines, is a feature of advanced renal failure and predicts worse survival. Dialysate IL-6 concentrations associate with variability in peritoneal small solute transport rate (PSTR), which has also been linked to patient survival. Here, we determined the link between systemic and intraperitoneal inflammation with regards to peritoneal membrane function and patient survival as part of the Global Fluid Study, a multinational, multicenter, prospective, combined incident and prevalent cohort study (n=959 patients) with up to 8 years of follow-up. Data collected included patient demographic characteristics, comorbidity, modality, dialysis prescription, and peritoneal membrane function. Dialysate and plasma cytokines were measured by electrochemiluminescence. A total of 426 survival endpoints occurred in 559 incident and 358 prevalent patients from 10 centers in Korea, Canada, and the United Kingdom. On patient entry to the study, systemic and intraperitoneal cytokine networks were dissociated, with evidence of local cytokine production within the peritoneum. After adjustment for multiple covariates, systemic inflammation was associated with age and comorbidity and independently predicted patient survival in both incident and prevalent cohorts. In contrast, intraperitoneal inflammation was the most important determinant of PSTR but did not affect survival. In prevalent patients, the relationship between local inflammation and membrane function persisted but did not account for an increased mortality associated with faster PSTR. These data suggest that systemic and local intraperitoneal inflammation reflect distinct processes and consequences in patients treated with peritoneal dialysis, so their prevention may require different therapeutic approaches; the significance of intraperitoneal inflammation requires further elucidation.
URI
http://hdl.handle.net/YU.REPOSITORY/28239http://dx.doi.org/10.1681/ASN.2013030314
ISSN
1046-6673
Appears in Collections:
의과대학 > 내과학교실 > Articles
Files in This Item:
There are no files associated with this item.
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE