title: High Levels of Soluble C5b-9 Complex in Dialysis Fluid May Predict Poor Prognosis in Peritonitis in Peritoneal Dialysis Patients.
abstract: BACKGROUND
  We searched for indicators to predict the prognosis of infectious peritonitis by measuring levels of complement proteins and activation products in peritoneal dialysis (PD) fluid (PDF) of patients at early stages of peritonitis. We retrospectively analyzed the relationship between the levels of sC5b-9, C3 and C4 in PDF and the subsequent clinical prognosis.
  
  
  METHODS
  We measured levels of sC5b-9, C3 and C4 in PDF on days 1, 2 and 5 post-onset of peritonitis in 104 episodes of infectious peritonitis in PD patients from 2008 and retrospectively compared levels with clinical outcomes. Further analysis for the presence of causative microorganisms or to demonstrate bacterial culture negative peritonitis was performed and correlated with change of levels of sC5b-9 in PDF.
  
  
  RESULTS
  When PD patients with peritonitis were divided into groups that either failed to recover from peritonitis and were finally withdrawn from PD (group 1; n = 25) or recovered (group 2; n = 79), levels of sC5b-9, C3 and C4 in PDF were significantly higher in group 1 patients compared to those in group 2 on day5. Analysis of microorganisms showed significantly higher sC5b-9 levels in PDF of peritonitis cases caused by culture negative peritonitis in group 1 compared with group 2 when we analyzed for individual microorganisms. Of note, on day5, the sC5b-9 levels in PDF were similarly high in peritonitis caused by fungi or other organisms.
  
  
  CONCLUSIONS
  Our results suggested that levels of complement markers in PDF, especially sC5b-9, have potential as surrogate markers to predict prognosis of PD-related peritonitis.
authors.affiliation: Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.|Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Higashide
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Sei
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Iguchi
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Fumiko
authors.initials: F
authors.lastname: Sakata
authors.affiliation: Daiyukai-daiichi Hospital, Ichinomiya, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Horie
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.affiliation: Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Complement Biology Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom.
authors.forename: B Paul
authors.initials: BP
authors.lastname: Morgan
authors.affiliation: Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.|Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D015938:Complement Membrane Attack Complex / Q000378:metabolism*; D015314:Dialysis Solutions; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis* / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003176:Complement C3; D003181:Complement C4; D015938:Complement Membrane Attack Complex; D015314:Dialysis Solutions; C047610:SC5b-9 protein complex