title: Diagnostic and prognostic role of peritoneal CA 125 in peritoneal dialysis patients presenting with acute peritonitis.
abstract: BACKGROUND
  Cancer antigen 125 (CA125) is made by peritoneal mesothelial cells and can be measured in spent dialysate effluent from peritoneal dialysis (PD) patients. It has been suggested that CA125 is a marker of peritoneal mesothelial cell mass and turnover. As PD CA125 increases during peritoneal inflammation, we wished to determine whether measuring PD CA125 during peritonitis provided additional information in determining outcome of peritonitis.
  
  
  METHODS
  We prospectively measured peritoneal CA125 in 127 adult PD patients presenting with 187 acute episodes of PD peritonitis, measuring peritoneal CA125 from a sample of dialysate effluent obtained from a 4 hour 2 litre 13.6 g/l dextrose peritoneal dwell.
  
  
  RESULTS
  Mean patient age 60.8 ± 17.1 years, 62.6% male, 33.7% diabetic and the median PD vintage was 22 (11-48) months. 127 patients (66.8%) presented with their first episode of peritonitis, 20% their second episode, 13.2% third or greater. Gram positive bacteria accounted for 64.7% of all peritonitis episodes and Gram negative bacteria 21.1%. Treatment was successful for 151 episodes of PD peritonitis (81.1%). The median PD effluent total WBC was 1240 (430-3660)/ml and serum CRP 67 (20-144) mg/l, with a PD CA125 of 38 (20.3-72.3) IU/l on presentation. There were positive correlations between PD effluent CA125 concentrations and total WBC on presentation (r = 0.41, p =  <0.001) and dialysis vintage (r =  -0.43, p < 0.001) but not with patient age, diabetic status, or serum CRP.There was no difference in PD effluent CA125 concentrations between Gram positive, and Gram negative peritonitis or between those episodes which responded to treatment, median 38 IU/ml (21-69) vs those with treatment failures 38 IU/ml (15-94).
  
  
  CONCLUSIONS
  We did not find any additional diagnostic or prognostic benefit for measuring effluent CA125 in PD patients presenting with acute peritonitis compared to standard investigations, including peritoneal WBC and serum CRP. As such our study would not support the routine measurement of peritoneal CA125 during episodes of peritonitis.
authors.forename: Kwanpeemai
authors.initials: K
authors.lastname: Panorchan
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, Rowland Hill Street, NW3 2PF London, UK. andrewdavenport@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000737:chemistry; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D018394:CA-125 Antigen / Q000032:analysis / Q000378:metabolism*; D015314:Dialysis Solutions / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000032:analysis / Q000378:metabolism*; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D010538:Peritonitis / Q000175:diagnosis* / Q000378:metabolism* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen; D015314:Dialysis Solutions; C451759:MUC16 protein, human; D008565:Membrane Proteins