Dialysate hyaluronan concentration predicts survival but not peritoneal sclerosis in continuous ambulatory peritoneal dialysis

Hyaluronan is an important component of extracellular matrix and plays a cr itical role in early phases of wound healing. Peritoneal mesothelium is a m ajor site of hyaluronan production. Serum hyaluronan concentration has been shown to predict survival in maintenance hemodialysis patients. We hypothe size that mesothelial production of hyaluronan during the stable phase of c ontinuous ambulatory peritoneal dialysis (CAPD) predicts the risk of perito neal adhesion and mortality. We studied peritoneal dialysate effluent (PDE) hyaluronan levels from 116 stable CAPD patients. They were then followed-u p for 3 years. During the follow-up period, there were 196 episodes of peri tonitis in 78 patients. Tenckhoff catheter was removed in 31 episodes (15.8 %). Tenckhoff catheter was reinserted successfully in 12 cases, and CAPD wa s resumed. Peritoneal adhesion developed in 16 cases. Three patients died b efore Tenckhoff catheter reinsertion was attempted. There was no difference in stable-phase PDE hyaluronan levels between patients who developed perit oneal adhesion and those who did not (159 +/- 63 versus 227 +/- 194 mu g/L, P = 0.27). Thirty-three patients died during the study period. Patients wh o died had significantly higher PDE hyaluronan concentration than survivors (272 +/- 194 versus 170 +/- 105 mu g/L, P < 0.01). Univariate analysis sho wed that increased PDE hyaluronan level was associated with a shorter patie nt survival (P < 0.001). There was no association between PDE hyaluronan le vel and serum albumin, protein nitrogen appearance, and percentage of lean body mass. Multivariate analysis confirmed that PDE hyaluronan level, serum albumin, and diabetic state were independent predictors of survival. We co nclude that PDE hyaluronan level during stable phase of CAPD does not predi ct the risk of postperitonitis adhesion. However, it is a strong independen t predictor of survival in CAPD patients. (C) 2000 by the National Kidney F oundation, Inc.