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.
Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.
Terhi A
TA
Martikainen
Agneta V
AV
Ekstrand
Eero O
EO
Honkanen
Anna-Maija
AM
Teppo
Carola
C
Grönhagen-Riska
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