title: Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution.
abstract: BACKGROUND
  Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical factors at peritoneal dialysis initiation, including peritoneal transport status, are associated with cardiovascular event in patients using biocompatible peritoneal dialysis solution.
  
  
  METHODS
  This retrospective cohort study of peritoneal dialysis patients using biocompatible solutions with neutral pH assessed relations of clinical parameters at peritoneal dialysis initiation to cardiovascular event during the subsequent five years.
  
  
  RESULTS
  Of 102 patients who started peritoneal dialysis, cardiovascular event occurred in 18. Age, history of cardiovascular disease before peritoneal dialysis initiation, hemoglobin, serum albumin, C-reactive protein, peritoneal permeability defined by the ratio of dialysate to plasma creatinine concentration at 4 hr (D/Pcre) in peritoneal equilibration test (PET), number of patients in each PET category defined by D/Pcre, and peritoneal protein clearance significantly differed between patients with and without cardiovascular event. For patients divided according to PET category using Kaplan-Meier method, the group of high average to high peritoneal transporters exhibited significantly high incidence of cardiovascular event and mortality compared with the groups of low and low-average peritoneal transporters (Log rank; p=0.0003 and 0.005, respectively). A Cox proportional hazards model showed independent association of PET category classification with cardiovascular event.
  
  
  CONCLUSIONS
  Peritoneal permeability expressed as PET category at peritoneal dialysis initiation is an independent cardiovascular risk factor in peritoneal dialysis patients using biocompatible peritoneal dialysis solution with neutral pH. Greater peritoneal permeability at peritoneal dialysis initiation might reflect subclinical vascular disorders.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Hamasaki
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Tanaka
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
authors.forename: Masaomi
authors.initials: M
authors.lastname: Nangaku
authors.affiliation: Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan. noiri-tky@umin.ac.jp.
authors.forename: Eisei
authors.initials: E
authors.lastname: Noiri
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D004058:Diffusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000187:drug effects* / Q000378:metabolism; D010539:Permeability / Q000187:drug effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D015314:Dialysis Solutions; D003404:Creatinine