Dialysate MCP-1 concentration is associated with all-cause mortality in peritoneal dialysis patients : a prospective observational study

Abstract

Background: The aim of this study was to investigate the association of the level of dialysate monocyte chemoattractant protein-1 (dMCP-1) with systemic inflammatory and nutritional markers in peritoneal dialysis (PD) patients. In addition, I examined the prognostic value of dMCP-1 on all-cause or cardiovascular mortality in these patients.Methods:I prospectively followed up 169 prevalent PD patients from April 2008 to December 2012. At baseline, dMCP-1 and serum biochemical parameters, including high sensitivity C-reactive protein (hs-CRP) and albumin, were checked. All-cause mortality and the causes of death were determined during the follow-up period. Based on the median level of dMCP-1, patients were classified into two group; low and high dMCP-1 groups.Results:Mean age, hs-CRP concentrations, and dialysate-to-plasma creatinine ratio (D/Pcr) at 4-hour were significantly higher, while serum albumin levels and %lean body mass (LBM) were significantly lower in the high dMCP-1 group. During the mean follow-up period of 47.7 months, all-cause mortality and cardiovascular mortality rates were significantly higher in the high dMCP-1 group (9.6 and 6.3 per 100 person-years, respectively) compared to the low dMCP-1 group (5.1 and 3.1 per 100 person-years; P=0.021 and 0.038, respectively). In multivariate Cox analysis, high dMCP-1 was a significant independent predictor of all-cause mortality (hazard ratio: 1.83, 95% confidence interval: 1.03-3.24, P=0.039). Moreover, multivariate fractional polynomial analysis showed that all-cause mortality and cardiovascular death increased steadily with higher dMCP-1 concentrations.Conclusion:dMCP-1 levels are closely correlated with nutritional and systemic inflammatory markers in PD patients. Furthermore, high dMCP-1 concentration is significantly associated with worse all-cause and cardiovascular outcomes. These findings suggest that local peritoneal inflammation can contribute to poor clinical outcomes in PD patients.