Lambie, MR and Chess, J and Summers, AM and Williams, PF and Topley, N and Davies, SJ (2016) Peritoneal inflammation precedes encapsulating peritoneal sclerosis: results from the GLOBAL Fluid Study. Nephrology Dialysis Transplantation, 31 (3). 480 -486. ISSN 1460-2385

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Abstract

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is an uncommon condition, strongly associated with a long duration of peritoneal dialysis (PD), which is itself associated with increased fibrosis in the peritoneal membrane. The peritoneal membrane is inflamed during PD and inflammation is often associated with fibrosis. We hypothesized that patients who subsequently develop EPS might have a more inflamed peritoneal membrane during PD. METHODS: We performed a nested, case-control study identifying all EPS cases in the UK arm of the GLOBAL Fluid Study and matching them by centre and duration of PD with two to three controls. Dialysate and plasma samples were taken during repeated peritoneal equilibration tests prior to cessation of PD from cases and controls. Samples were assayed by electrochemiluminescence immunoassay for interleukin-1β (IL-1β), tumour necrosis factor α (TNF-α), interferon-γ (IFN-γ) and IL-6. Results were analysed by linear mixed models adjusted for age and time on PD. RESULTS: Eleven EPS cases were matched with 26 controls. Dialysate TNF-α {0.64 [95% confidence interval (CI) 0.23, 1.05]} and IL-6 [0.79 (95% CI 0.03, 1.56)] were significantly higher in EPS cases, while IL-1β [1.06 (95% CI -0.11, 2.23)] and IFN-γ [0.62 (95% CI -0.06, 1.29)] showed a similar trend. Only IL-6 was significantly higher in the plasma [0.42 (95% CI 0.07, 0.78)]. Solute transport was not significantly different between cases and controls but did increase in both groups with the duration of PD. CONCLUSIONS: The peritoneal cavity has higher levels of inflammatory cytokines during PD in patients who subsequently develop EPS, but neither inflammatory cytokines nor peritoneal solute transport clearly discriminates EPS cases. Increased systemic inflammation is also evident and is probably driven by increased peritoneal inflammation.

Item Type: Article
Additional Information: GLOBAL Fluid Study Investigators. This is the accepted author manuscript (AAM). The final published version (version of record) is available online via [insert publisher name] at [insert hyperlink]. Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Body Fluids, chronic inflammation, Cytokines, Dialysis Solutions, encapsulating peritoneal sclerosis, Female, Follow-Up Studies, GLOBAL Fluid Study Investigators, Humans, Male, Middle Aged, peritoneal dialysis, Peritoneal Dialysis, Peritoneal Fibrosis, peritoneal membrane, Peritoneum, Peritonitis, Prevalence, Retrospective Studies, United Kingdom
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
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Depositing User: Symplectic
Date Deposited: 21 Apr 2017 09:19
Last Modified: 21 Apr 2017 12:58
URI: http://eprints.keele.ac.uk/id/eprint/3282

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