Relationships Between Peritoneal Protein Clearance and Parameters of Fluid Status Agree with Clinical Observations in Other Diseases that Venous Congestion Increases Microvascular Protein Escape.

Autor:	Krediet RT; Department of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands., Yoowannakul S; UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom., Harris LS; UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom., Davenport A; UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom andrewdavenport@nhs.uk.
Jazyk:	angličtina
Zdroj:	Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis [Perit Dial Int] 2019 Mar-Apr; Vol. 39 (2), pp. 155-162. Date of Electronic Publication: 2019 Jan 18.
DOI:	10.3747/pdi.2018.00016
Abstrakt:	Background: Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal microvessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements. Methods: A total of 316 adult PD patients, on PD for 8 - 12 weeks and collecting 24-hour urine and dialysate for total protein determination, underwent standard peritoneal equilibration testing (PET) along with measurement of N terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), multifrequency bioimpedance analysis, and a transthoracic echocardiogram. Results: Statistically significant univariate relationships for peritoneal protein clearance with a Spearman correlation coefficient > 0.25 were present for 4-hour dialysate/plasma (D/P) creatinine, NT-proBNP, extracellular/total body water, extracellular water excess, left ventricular mass, and right atrial area. Negative correlations were found with serum total protein and residual renal function. On multivariate analysis, logNTproBNP (β 0.11, p = 0.007) and right atrial area (β 0.01, p = 0.03) were significant independent predictors of peritoneal protein clearance. Conclusion: Indicators of venous congestion showed the most important relationships with peritoneal protein clearance. These indicators have not been assessed in previous studies on the presence or absence of relationships between peritoneal protein clearance and mortality. (Copyright © 2019 International Society for Peritoneal Dialysis.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu