Peritoneal loss of insulin-like growth factor-I and binding proteins in end-stage renal disease.
The kinetics of peritoneal transport of insulin-like growth factor (IGF) system-related proteins during dialysis is not well characterized. We studied temporal changes in dialysate and serum concentrations of IGF-I and IGF-II as well as IGF binding protein (BP)-1, -2, and -3 in ten children with end-stage renal disease (ESRD) undergoing continuous cycling peritoneal dialysis (CCPD) during a 4-h peritoneal equilibration test (PET). Dialysate concentrations of IGF-I, IGF-II, and all three IGFBPs demonstrated a time-dependent increase during PET. Despite their transport, the serum concentrations of these proteins did not change significantly during the PET. Dialysate/serum ratios for IGF-I, IGF-II, and IGFBP-1, -2, and -3 were significantly increased at 2 h and increased further at 4 h, at which time values averaged 1.3+/-0.2%, 3.1+/-0.5%, 6.2+/-1.0%, 2.4+/-0.2%, and 1.3+/-0.2% of serum levels, respectively. The transperitoneal clearance (microl/min per 1.73 m2) of the three IGFBPs was inversely related to both their molecular weight and plasma concentration. However, peritoneal clearance of IGF-I and -II was similar to that of the larger and more-abundant IGFBP-3. Mass transfer rates (microg/h per 1.73 m2) for the IGFs and their binding proteins were directly proportional to their prevailing plasma concentration. Based on estimates of mass transfer, only a small molar excess of IGFBPs was removed from the circulation relative to the combined molar concentration of IGF-I and IGF-II. Hence, it seems unlikely that any beneficial effect of CCPD on growth in children with ESRD is mediated via a preferential loss of IGFBPs into the dialysate fluid.
Department of Pediatrics, Baskent University, Ankara, Turkey.
G
G
Bereket
J J
JJ
Lin
A
A
Bereket
C H
CH
Lang
F J
FJ
Kaskel
D015153:Blotting, Western; D002648:Child; D015314:Dialysis Solutions / Q000378:metabolism; D005260:Female; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000378:metabolism; D018971:Insulin-Like Growth Factor Binding Protein 2 / Q000378:metabolism; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000378:metabolism; D018969:Insulin-Like Growth Factor Binding Proteins / Q000378:metabolism*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy; D007677:Kidney Function Tests; D007700:Kinetics; D008024:Ligands; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory
D015314:Dialysis Solutions; D018970:Insulin-Like Growth Factor Binding Protein 1; D018971:Insulin-Like Growth Factor Binding Protein 2; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins; D008024:Ligands; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II