Gut Permeability, Circulating Bacterial Fragments, and Measures of Congestion in Peritoneal Dialysis
Chuanlei Li, Jack Kit-Chung Ng, Gordon Chun-Kau Chan, Winston Wing-Shing Fung, Ka-Bik Lai, Peter Yam-Kau Poon, Cathy Choi-Wan Luk, Kai-Ming Chow, Cheuk-Chun Szeto- Transplantation
- Nephrology
Abstract
Background
Limited data exists on the association between gut permeability, circulating bacterial fragment, and volume overload in peritoneal dialysis (PD) patients. We measured circulating bacterial fragments, NT-proBNP, calprotectin, and zonulin levels, and evaluate their association with the clinical outcomes in PD patients.
Methods
This is a single-center prospective study on 108 consecutive incident PD patients. Plasma endotoxin and bacterial DNA, and serum NT-proBNP, calprotectin and zonulin levels were measured. Primary outcomes were technique and patient survival, secondary outcomes were hospitalization data.
Results
There was no significant correlation between plasma endotoxin and bacterial DNA, and serum NT-proBNP, calprotectin and zonulin levels. The HOMA-2β index, which represents insulin resistance, positively correlated with plasma bacterial DNA (r=0.421, p<0.001) and calprotectin levels (r=0.362, p=0.003), while serum NT-proBNP level correlates with the severity of volume overload and residual renal function. Serum NT-proBNP level was associated with technique survival even after adjusting for confounding factors (adjusted hazard ratio [AHR] 1.030, 95% confidence interval [CI] 1.009-1.051). NT-proBNP level was also associated with patient survival by univariate analysis, but the association became insignificant after adjusting for confounding factors (AHR 1.010, p=0.073). Similarly, NT-proBNP correlated with the number of hospitalizations and duration of hospitalization by univariate analysis, but the association became insignificant after adjusting for confounding factors.
Conclusion
There was no correlation between markers of gut permeability, circulating bacterial fragments, and measures of congestion in PD patients. Bacterial fragments levels and gut permeability are both associated with insulin resistance. Serum NT-proBNP level is associated with the severity of volume overload and technique survival. Further studies are required to delineate the mechanism of high circulating bacterial fragment levels in PD patients.