Objective To explore the factors affecting the long-term trends of peritoneal water transport and solute transport in incident peritoneal dialysis patients. Methods Incident peritoneal dialysis patients were recruited at Peking University First Hospital from January 1, 2016, to April 30, 2019. Baseline data including demographics, clinical biochemistry, dialysis prescription, and dialysis adequacy and transport test were collected. Spearman's correlation analysis was used to explore the factors affecting patients' baseline ultrafiltration per glucose load and 24-hour dialysate-to-plasma creatinine ratio (24h D/P Cr). Factors that influenced the trends of patients' ultrafiltration per glucose load and 24h D/P Cr were analyzed using mixed linear modeling. Results A total of 197 incident peritoneal dialysis patients who were clinically stable were included in this study. A positive correlation between continuous dialysis (r=0.227, P=0.001), baseline exposure of glucose (r=0.140, P=0.049) and baseline 24h D/P Cr was observed. Cardiovascular disease (r=0.144, P=0.043), new-onset peritonitis (r=0.168, P=0.018), and baseline exposure of glucose at baseline (r=0.252, P＜0.001) were positively correlated with baseline ultrafiltration per glucose load. In contrast, baseline blood albumin (r=-0.192, P=0.007) and renal Kt/V (r=-0.340, P＜0.001) showed a negative correlation with ultrafiltration per glucose load. A gradual increasing trend in ultrafiltration per glucose load (t=-4.196，P＜0.001) was observed in our peritoneal dialysis patients using mixed linear modeling but was not associated with age, gender, diabetes, cardiovascular disease, Charlson comorbidity score, baseline hemoglobin, baseline blood albumin, baseline hypersensitive C-reactive protein (hs-CRP), baseline diastolic blood pressure, baseline systolic blood pressure, new-onset peritonitis, intermittent or continuous dialysis, baseline renal Kt/V, and aquaporin-1 (AQP1) promoter genotype (P>0.050). Meanwhile, 24h D/P Cr remained relatively stable (t=-1.486，P=0.138) during follow-up. Conclusion This study demonstrated that an increasing trend in ultrafiltration per glucose load and a stable trend in 24h D/P Cr were observed in our incident peritoneal dialysis patients, which may be associated with our incremental dialysis and glucose-sparing strategies. This supported that peritoneal membrane function in peritoneal dialysis patients is influenced by a combination of environmental and genetic factors.
[1]CHINA N H C O P R. Chinese National Renal Data System [Z]. National Health Commission of P. R. China
[2]YEATES K, ZHU N, VONESH E, et al. Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada [J]. Nephrol Dial Transplant, 2012, 27(9): 3568-75.
[3]VAN DE LUIJTGAARDEN M W, NOORDZIJ M, STEL V S, et al. Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe [J]. Nephrol Dial Transplant, 2011, 26(9): 2940-7.
[4]MEHROTRA R, CHIU Y W, KALANTAR-ZADEH K, et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease [J]. Arch Intern Med, 2011, 171(2): 110-8.
[5]BOUDVILLE N, DE MORAES T P. 2005 Guidelines on targets for solute and fluid removal in adults being treated with chronic peritoneal dialysis: 2019 Update of the literature and revision of recommendations [J]. Perit Dial Int, 2020, 40(3): 254-60.
[6]MEHROTRA R, STANAWAY I B, JARVIK G P, et al. A genome-wide association study suggests correlations of common genetic variants with peritoneal solute transfer rates in patients with kidney failure receiving peritoneal dialysis [J]. Kidney Int, 2021, 100(5): 1101-11.
[7]RUMPSFELD M, MCDONALD S P, PURDIE D M, et al. Predictors of baseline peritoneal transport status in Australian and New Zealand peritoneal dialysis patients [J]. Am J Kidney Dis, 2004, 43(3): 492-501.
[8]MENDLEY S R, MAJKOWSKI N L. Peritoneal equilibration test results are different in infants, children, and adults [J]. J Am Soc Nephrol, 1995, 6(4): 1309-12.
[9]SHI Y, YAN H, YUAN J, et al. Different patterns of inflammatory and angiogenic factors are associated with peritoneal small solute transport and peritoneal protein clearance in peritoneal dialysis patients [J]. BMC Nephrol, 2018, 19(1): 119.
[10]MORELLE J, MARECHAL C, YU Z, et al. AQP1 Promoter Variant, Water Transport, and Outcomes in Peritoneal Dialysis [J]. N Engl J Med, 2021, 385(17): 1570-80.
[11]DAVENPORT A, WILLICOMBE M K. Hydration status does not influence peritoneal equilibration test ultrafiltration volumes [J]. Clin J Am Soc Nephrol, 2009, 4(7): 1207-12.
[12]LI Z, YAN H, YUAN J, et al. Pharmacological inhibition of heparin-binding EGF-like growth factor promotes peritoneal angiogenesis in a peritoneal dialysis rat model [J]. Clin Exp Nephrol, 2018, 22(2): 257-65.
[13]YUAN J, FANG W, NI Z, et al. Peritoneal morphologic changes in a peritoneal dialysis rat model correlate with angiopoietin/Tie-2 [J]. Pediatr Nephrol, 2009, 24(1): 163-70.
[14]GAROSI G, DI PAOLO N, SACCHI G, et al. Sclerosing peritonitis: a nosological entity [J]. Perit Dial Int, 2005, 25 Suppl 3: S110-2.
[15]SIA C S B, PAUL E, TREGASKIS P, et al. The longitudinal effects of peritonitis on peritoneal membrane function? [J]. Clin Nephrol, 2017, 88(12): 311-6.
[16]GOKAL R, KHANNA R, KREDIET R T, et al. Textbook of peritoneal dialysis [M]. Springer Science & Business Media, 2013.
[17]王海燕. 肾脏病学 [M]. 第4版 ed. 北京: 人民卫生出版社, 2020.
[18]ZHOU X J, XU X, DONG J. AQP1 Promoter Variant, Water Transport, and Outcome in Peritoneal Dialysis [J]. N Engl J Med, 2022, 386(11): 1096.
[19]DAVIES S J. Longitudinal relationship between solute transport and ultrafiltration capacity in peritoneal dialysis patients [J]. Kidney Int, 2004, 66(6): 2437-45.
[20]SZETO C C, KWAN B C, CHOW K M, et al. Predictors of residual renal function decline in patients undergoing continuous ambulatory peritoneal dialysis [J]. Perit Dial Int, 2015, 35(2): 180-8.
[21]HTAY H, CHO Y, PASCOE E M, et al. Predictors of Residual Renal Function Decline in Peritoneal Dialysis Patients: The balANZ Trial [J]. Perit Dial Int, 2017, 37(3): 283-9.
[22]PARK S H, DO J Y, KIM Y H, et al. Effects of neutral pH and low-glucose degradation product-containing peritoneal dialysis fluid on systemic markers of inflammation and endothelial dysfunction: a randomized controlled 1-year follow-up study [J]. Nephrol Dial Transplant, 2012, 27(3): 1191-9.
[23]PAGNIEZ D, DUHAMEL A, BOULANGER E, et al. No increase in small-solute transport in peritoneal dialysis patients treated without hypertonic glucose for fifty-four months [J]. BMC Nephrol, 2017, 18(1): 278.
[24]NOLPH K D. Rationale for early incremental dialysis with continuous ambulatory peritoneal dialysis [J]. Nephrol Dial Transplant, 1998, 13 Suppl 6: 117-9.
[25]BLAKE P G, DONG J, DAVIES S J. Incremental peritoneal dialysis [J]. Perit Dial Int, 2020, 40(3): 320-6.
[26]LINDLEY E, TATTERSALL J. Don't deny it! Incremental dialysis is compassionate, logical, and patient-centered [J]. Kidney Int, 2022, 101(3): 465-8.
[27]MEHROTRA R, DEVUYST O, DAVIES S J, et al. The Current State of Peritoneal Dialysis [J]. J Am Soc Nephrol, 2016, 27(11): 3238-52.
[28]DE VECCHI A F, SCALAMOGNA A, FINAZZI S, et al. Preliminary evaluation of incremental peritoneal dialysis in 25 patients [J]. Perit Dial Int, 2000, 20(4): 412-7.
[29]MORELLE J, STACHOWSKA-PIETKA J, OBERG C, et al. ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: Classification, measurement, interpretation and rationale for intervention [J]. Perit Dial Int, 2021, 41(4): 352-72.
