Dialysate leukocytes, sICAM-1, hyaluronan and IL-6: predictors of outcome of peritonitis?
OBJECTIVE
Despite effective antibiotic therapy, peritonitis still remains a major problem in peritoneal dialysis (PD). The aim of the present study was to investigate changes of CRP, dialysate leukocytes and IL-6, hyaluronan (HA) and sICAM-1 in dialysate during and after peritonitis and their association to the outcome of peritonitis.


METHODS
Dialysate IL-6, HA and sICAM-1 were measured at the onset and on day 4, at the end of the treatment and 2 months after onset of peritonitis. Furthermore, CRP and dialysate leukocytes were measured on days 1-4.


RESULTS
All measured soluble factors were higher on the first and fourth day than at the end of the treatment. sICAM-1 and HA were lower at the end of the treatment in patients who later had a relapse/re-infection. IL-6 remained higher 2 months after clinically cured peritonitis. CRP and dialysate leukocytes were higher on day 4 in patients with poor outcome.


CONCLUSIONS
Peritonitis causes increased excretion of soluble factors. Low concentrations of sICAM-1 and HA at the end of the treatment were negative prognostic indicators. Higher IL-6 levels after peritonitis could be a sign of ongoing inflammation in the peritoneal membrane. Delayed decrease in CRP and dialysate leukocytes may indicate poor outcome.
Martikainen
Terhi A
TA
Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.
Ekstrand
Agneta V
AV
Honkanen
Eero O
EO
Teppo
Anna-Maija
AM
Grönhagen-Riska
Carola
C
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis*; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis*; D015850:Interleukin-6 / Q000032:analysis*; D007958:Leukocyte Count; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D015850:Interleukin-6; D018799:Intercellular Adhesion Molecule-1; D006820:Hyaluronic Acid; D002097:C-Reactive Protein