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Division of Renal Medicine and Baxter Novum,1 Karolinska Institutet, Stockholm, Sweden; Department of Nephrology,2 Hospital Geral de Santo António, Porto, Portugal; Centro de Ciências Biológicas e da Saúde,3 Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
Correspondence to: R. Pecoits-Filho, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, K-56, Huddinge University Hospital, 141 86 Stockholm, Sweden.roberto.pecoits-filho{at}klinvet.ki.se
Objective: To investigate if intraperitoneal and
systemic interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) are related
to each other and to peritoneal solute transport rate (PSTR). Design: Longitudinal study in retrospectively selected
patients. Setting: Peritoneal dialysis (PD) unit of a
university-based hospital. Patients and Methods: 31 PD patients on treatment with
conventional glucose-based solutions participated in a longitudinal study.
IL-6 and sIL-6R were measured in plasma and overnight effluent, both at
baseline and after 12 ± 2 months on PD. C-reactive protein (CRP) and
serum albumin were used as surrogate markers of inflammation. PSTR of small
solutes was evaluated using the dialysate-to-plasma ratio (D/P) of creatinine
after a 4-hour dwell; PSTR of large solutes was evaluated using the 24-hour
D/P ratio of albumin. Results: D/P creat increased over time (0.67 ±
0.15 vs 0.80 ± 0.11, p < 0.0001) and correlated to D/P
albumin only at the baseline evaluation. Patients with plasma IL-6 
median
had higher (p < 0.005) D/P creat at baseline [0.74 (0.62 –
0.87)] compared to patients with IL-6 < median [0.57 (0.47 – 0.66)].
Dialysate IL-6 at baseline was also higher (p < 0.05) in patients
with plasma IL-6 median [24.7 (16.5 – 38.5) pg/mL] compared to
patients with IL-6 < median [14.1 (10 – 25.7) pg/mL]. Neither CRP nor
albumin changed over time on PD, although they were closely linked to plasma
IL-6 levels. A strong positive correlation was found between D/P creat and
dialysate IL-6 (rho = 0.77, p < 0.0001) at baseline, but not at 1
year. In contrast, there was a significant correlation between D/P creat and
dialysate sIL-6R (rho = 0.39, p < 0.05) at 1 year, but not at
baseline. At 1 year, 17 patients with increasing PSTR had higher increases in
dialysate IL-6 (28 ± 26 vs –21 ± 78 pg/mL, p <
0.05) and levels of dialysate sIL-6R (693 ± 392 vs 394 ± 274
pg/mL, p = 0.05) compared to patients with stable PSTR (n =
11). Patients who had peritonitis presented higher baseline serum IL-6
concentration (6.8 ± 1.0 pg/mL) compared with patients without
peritonitis (4.0 ± 0.6 pg/mL, p < 0.05). Finally, both at
baseline and after 1 year, there were significant correlations between plasma
and dialysate IL-6 (rho = 0.46, p < 0.05, and rho = 0.40,
p < 0.05) respectively. Conclusions: These findings indicate that, (1)
intraperitoneal and systemic inflammation increase in PD patients during the
first year of therapy; (2) intraperitoneal and systemic inflammation may be
interrelated and the IL-6 system may be the link; (3) the IL-6 system (both
intraperitoneal and systemic) is associated with PSTR, particularly in the
early phase of PD treatment, in which small and large solute transport are
linked. Signs of a transition between acute and chronic inflammation were
observed in the follow-up evaluation. Inflammation may, at least in part, be
responsible for the development of a high PSTR, and this could be one reason
for the high mortality in patients with high PSTR.
KEY WORDS: Peritoneal solute transport rate; inflammation; interleukin-6.
Received 13 January 2005; accepted 27 May 2005.
This article has been cited by other articles:
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  A. L. de Souza, J. Sztajnbok, M. Marques Salgado, C. C. Romano, M. das Gracas Adelino Alkmin, A. J. S. Duarte, and A. C. Seguro Compartmentalization of Interleukin-6 Response in a Patient with Septic Meningococcal Peritonitis Clin. Vaccine Immunol., November 1, 2006; 13(11): 1287 - 1290. [Abstract] [Full Text] [PDF]
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