Concentrations of IL-6, TNF-alpha, Phospholipid and CA125 in Dialysis Fluid during the Course of CAPD Peritonitis

Kang, Duk Hee

Abstract

Bacterial peritonitis remains one of the major problem in patients undegoing CAPD, resulting in massive mesothelial cell (MC) death, remesothelialization failure, fibrosis and sclerosis. Since the preservation of the functional integrity of peritoneal membrane as a dialyzing organ is essential, complete resolution and adequate remesothelialization are necessary. This study was performed to investigate the effects of peritonitis on the number, secretory and regulatory function of MC. Subjects were nine episodes of peritonitis in 7 CAPD patients (M:F 5:2, mean age 48 years, mean CAPD duration 46 months). Dialysate CA125 and phospholipid were measured as markers of MC mass, and we also check the level of IL-6 and TNF-alpha, specific cytokines which can be detected in dialysate effluent. The concentrations of above mentioned substances were measured from the first cloudy bag, and thereafter overnight effluent were collected daily during the course of peritonitis and 4 weeks after discontinuation of antibiotics. Dialysate CA125 reached a peak in 2nd day of peritonitis and showed a second peak in 7th day. Other substances also showed a sharp increase on 1st day of peritonitis, returned to the baseline value rapidly. No differences in changes in the dialysate CA125, phospholipid and cytokine levels were noted according to the causative organism. There was no significant correlation between the values of MC marker and cytokines. In one patients who experienced 3 consecutive peritonitis with one-month interval, there was no second peak in dialyste CA125 level, and phospholipid remained the lowest level. He finally died due to sclerosing peritonitis and sepsis. In conclusion, MC markers and cytokines in peritoneal effluent can be used to follow the effects of inflammation in the peritoneal cavity. CA125 can be regarded both as a marker of MC damage and regeneration. Therefore, regular follow-up of CA125 during peritonitis can be an indicator to adequate treatment and remesothelialization.