Endotoxemia in Peritoneal Dialysis Patients: A Pilot Study to Examine the Role of Intestinal Perfusion and Congestion.
Endotoxemia is common in advanced chronic kidney disease and is particularly severe in those receiving dialysis. In hemodialysis patients, translocation from the bowel occurs as a consequence of recurrent circulatory stress leading to a reduction in circulating splanchnic volume and increased intestinal permeability. Peritoneal dialysis (PD) patients are often volume expanded and have continuous direct immersion of bowel in fluid; these may also be important factors in endotoxin translocation and would suggest different therapeutic strategies to improve it. The mechanisms leading to endotoxemia have never been specifically studied in PD. In this study, 17 subjects (8 PD patients, 9 healthy controls) underwent detailed gastrointestinal and cardiac magnetic resonance imaging during fasted and fed states. Gross splanchnic perfusion was assessed by quantification of superior mesenteric artery flow. Magnetic resonance imaging findings were correlated to endotoxemia, markers of hydration status and cardiac structure and function.
University of Western Ontario, Kidney Clinical Research Unit, London, ON, Canada.
Claire
C
Grant
Royal Derby Hospital, Department of Renal Medicine, Derby, UK.
Laura
L
Harrison
University of Nottingham, Sir Peter Mansfield Imaging Centre, Nottingham, UK.
Caroline
C
Hoad
University of Nottingham, Nottingham Digestive Diseases Centre, Nottingham, UK.
Luca
L
Marciani
University of Nottingham, Sir Peter Mansfield Imaging Centre, Nottingham, UK.
Eleanor
E
Cox
University of Nottingham, Sir Peter Mansfield Imaging Centre, Nottingham, UK.
Charlotte
C
Buchanan
University of Nottingham, Sir Peter Mansfield Imaging Centre, Nottingham, UK.
Carolyn
C
Costigan
University of Nottingham, Sir Peter Mansfield Imaging Centre, Nottingham, UK.
Susan
S
Francis
The Chinese University of Hong Kong, Department of Medicine & Therapeutics, Sha Tin, Hong Kong.
Ka-Bik
KB
Lai
The Chinese University of Hong Kong, Department of Medicine & Therapeutics, Sha Tin, Hong Kong.
Cheuk-Chun
CC
Szeto
University of Nottingham, Sir Peter Mansfield Imaging Centre, Nottingham, UK.
Penny
P
Gowland
University of Western Ontario, Kidney Clinical Research Unit, London, ON, Canada cmcint48@uwo.ca.
Christopher
C
McIntyre
D000368:Aged; D016022:Case-Control Studies; D019446:Endotoxemia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D004731:Endotoxins / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000379:methods; D010865:Pilot Projects; D012016:Reference Values; D012380:Role; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
D004731:Endotoxins
Endotoxin; cardiovascular disease; dialysis; gastrointestinal perfusion