Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survival
Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survival
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DOI：
10.1681/asn.2013030314
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发表时间：
2013-12-01
影响因子：
13.6
通讯作者：
Topley, Nicholas
中科院分区：
文献类型：
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作者：
Lambie, Mark;Chess, James;Topley, Nicholas
全身性炎症，如炎症细胞因子升高所证明，是晚期肾衰竭的特征，预示着更差的生存。透析液IL-6浓度与腹膜小溶质转运率（PSTR）的变异性相关，PSTR也与患者生存有关。在这里，作为全球流体研究的一部分，我们确定了全身和腹膜内炎症与腹膜功能和患者生存之间的联系，这是一项多国、多中心、前瞻性、联合事件和流行队列研究（n=959例患者），随访时间长达8年。收集的数据包括患者的人口学特征、合并症、方式、透析处方和腹膜功能。电化学发光法测定透析液和血浆细胞因子。来自韩国、加拿大和英国10个研究中心的559例发病患者和358例流行患者共有426个生存终点。在患者进入研究时，全身和腹腔内的细胞因子网络被分离，有证据表明腹膜内局部细胞因子产生。在对多个协变量进行调整后，全身性炎症与年龄和合并症相关，并独立预测了事件和流行队列中患者的生存。相比之下，腹腔炎症是PSTR最重要的决定因素，但不影响生存。在流行的患者中，局部炎症和膜功能之间的关系持续存在，但并不能解释与PSTR更快相关的死亡率增加。这些数据表明，在接受腹膜透析治疗的患者中，全身和局部腹膜内炎症反映了不同的过程和后果，因此它们的预防可能需要不同的治疗方法；腹膜内炎症的意义有待进一步阐明。
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.