HYALURONIC-ACID METABOLISM AND ITS CLINICAL-SIGNIFICANCE IN PATIENTS TREATED BY CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Musculoskeletal syndromes are common in patients treated by dialysis f or end-stage renal failure and abnormal connective tissue metabolism h as been implicated. Hyaluronic acid is a major component of connective tissue ground substance. Serum, dialysate, and 24-h urine hyaluronic acid was therefore measured in 43 patients treated by CAPD to determin e hyaluronic acid metabolism and to relate these variables to morbidit y and mortality over an 18-month period. Serum hyaluronic acid was ele vated in 71 % patients, being correlated with patient age, length of t ime on dialysis, and weight loss over the preceding 6 months. Small qu antities of predominantly low-molecular-weight hyaluronic acid were lo st in the urine, whereas much larger amounts of mixed-molecular-weight hyaluronic acid were excreted in peritoneal dialysate. Dialysate hyal uronic acid exceeded serum hyaluronic acid. Baseline serum hyaluronic acid was closely correlated with morbidity and mortality over the foll owing 18 months. Serum hyaluronic acid is an accurate predictor of mor tality and morbidity over an 18-month period in patients treated by CA PD. Large quantities of hyaluronic acid are excreted in peritoneal dia lysate, which in part represents local hyaluronic acid production.