Intraperitoneal hyaluronan production in stable continuous ambulatory peritoneal dialysis patients

Objective: Several cytokines and proteins are excreted intraperitoneally du ring the course of peritonitis and stable states in continuous ambulatory p eritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also rega rded as a marker of peritoneal healing during bacterial peritonitis. We exa mined here, intraperitoneal HYA production in stable CAPD patients and comp ared the results to those of the peritoneal equilibration test (PET), the l ength of time on dialysis, and other marker proteins. Design: We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals. Setting: CAPD unit in Hitachi General Hospital. Patients:The subjects were 46 stable CAPD patients who underwent 104 PETs. Results: A correlation was found between the length of time on dialysis and the amount of HYA excretion in the Li-hr-dwell dialysate (r = 0.403, p < 0 .001). A positive but weak correlation was found between the dialysate-to-p lasma ratio of the creatinine concentration and dialysate HYA excretion (r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both th e concentration of HYA (>349.2 ng/mL) and the amount of HYA (>743.6 mu g/4- hr dwell). Five patients exceeded 1000 mu g of HYA excretion in the Lt-hr-d well dialysate, 4 of whom showed an abrupt increase of HYA excretion to mor e than 1000 mu g/4-hr dwell, and discontinued CAPD within 6 months due to u ltrafiltration failure. Two of these 4 patients were diagnosed with scleros ing encapsulating peritonitis at autopsy. Conclusion: Intraperitoneal HYA production increased with both higher perme able membrane and the length of time on CAPD. Monitoring of HYA in the peri toneal dialysate may be useful as a marker to assess functional and morphol ogical changes in the peritoneum in long-term CAPD patients.