title: Associations between the duration of dialysis, endotoxemia, monocyte chemoattractant protein-1, and the effects of a short-dwell exchange in patients requiring continuous ambulatory peritoneal dialysis.
abstract: BACKGROUND
  Endotoxemia is exaggerated and contributes to systemic inflammation and atherosclerosis in patients requiring continuous ambulatory peritoneal dialysis (CAPD). The risk of mortality is substantially increased in patients requiring CAPD for >2 years. However, little is known about the effects of long-term CAPD on circulating endotoxin and cytokine levels. Therefore, the present study evaluated the associations between plasma endotoxin levels, cytokine levels, and clinical parameters with the effects of a short-dwell exchange on endotoxemia and cytokine levels in patients on long-term CAPD.
  
  
  METHODS
  A total of 26 patients were enrolled and divided into two groups (short-term or long-term CAPD) according to the 2-year duration of CAPD. Plasma endotoxin and cytokine levels were measured before and after a short-dwell exchange (4-h dwell) during a peritoneal equilibration test (a standardized method to evaluate the solute transport function of peritoneal membrane). These data were analyzed to determine the relationship of circulating endotoxemia, cytokines and clinical characteristics between the two groups.
  
  
  RESULTS
  Plasma endotoxin and monocyte chemotactic protein-1 (MCP-1) levels were significantly elevated in the long-term group. PD duration was significantly correlated with plasma endotoxin (r = 0.479, P = 0.016) and MCP-1 (r = 0.486, P = 0.012). PD duration was also independently associated with plasma MCP-1 levels in multivariate regression. Plasma MCP-1 levels tended to decrease (13.3% reduction, P = 0.077) though endotoxin levels did not decrease in the long-term PD group after the 4-h short-dwell exchange.
  
  
  CONCLUSIONS
  Long-term PD may result in exaggerated endotoxemia and elevated plasma MCP-1 levels. The duration of PD was significantly correlated with circulating endotoxin and MCP-1 levels, and was an independent predictor of plasma MCP-1 levels. Short-dwell exchange seemed to have favorable effects on circulating MCP-1 levels in patients on long-term PD.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Inflammation Research and Drug Development Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Ping-Fang
authors.initials: PF
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Hsin Jen Hospital, Taipei, Taiwan.
authors.forename: Hung-Hsiang
authors.initials: HH
authors.lastname: Liou
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chirn-Bin
authors.initials: CB
authors.lastname: Chang
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chia-Chu
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000328:Adult; D018932:Chemokine CCL2 / Q000097:blood*; D019446:Endotoxemia / Q000097:blood* / Q000150:complications; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D013997:Time Factors; D055815:Young Adult
chemical_list: D018932:Chemokine CCL2; D004731:Endotoxins