Peritoneal Dialysis International, Vol. 22, pp. 670–676 Printed in Canada. All rights reserved. 0896-8608/02 $3.00 + .00 Copyright © 2002 International Society for Peritoneal Dialysis 670 SELECTED GROWTH FACTORS IN PERITONEAL DIALYSIS: THEIR RELATIONSHIP TO MARKERS OF INFLAMMATION, DIALYSIS ADEQUACY, RESIDUAL RENAL FUNCTION, AND PERITONEAL MEMBRANE TRANSPORT Tomasz Stompór, Anna Zdzienicka, 1 Marcin Motyka, 1 Aldona Dembin ´ska–Kiec ´, 1 Simon J. Davies, 2 and Wladyslaw Sulowicz Department of Nephrology; Department of Clinical Biochemistry, 1 Jagiellonian University, Kraków, Poland; Renal Medicine, 2 North Staffordshire Hospital, Stoke-on-Trent, United Kingdom Correspondence to: T. Stompór, Chair and Department of Nephrology, Jagiellonian University, 15c Kopernika Str., 31-501 Kraków, Poland. stompin@mp.pl Received 6 December 2001; accepted 2 July 2002. ♦ Objectives: Markers of chronic inflammation, acute- phase reactants, and growth factors may be concomitantly involved in a number of pathologic processes in the gen- eral population and uremic patients. In addition, growth factors may influence peritoneal membrane transport characteristics. However, the association between plasma growth factors, markers of chronic inflammation, and peri- toneal membrane transport remains largely unknown. The aim of this study was to evaluate the relationship between plasma levels of selected growth factors [basic fibroblast growth factor (bFGF), transforming growth factor β1 (TGFβ1), vascular endothelial growth factor (VEGF)] and markers of chronic inflammation [interleukin (IL)-6, C-re- active protein (CRP), and fibrinogen] in continuous am- bulatory peritoneal dialysis (CAPD) patients. The potential link between the above substances and dialysis adequacy was also explored. ♦ Design: Single-center, cross-sectional study. ♦ Setting: Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Kraków, Poland. ♦ Patients: 32 stable end-stage renal disease patients (13 M, 19 F; mean age 53.6 ± 13.7 years) on CAPD for a median period of 19.5 months. Patients free from signs and symptoms of any inflammatory disease (including peritonitis) for at least 3 months were included into the study. All patients underwent measurements of dialysis dose [Kt/V, weekly creatinine clearance (wCCr)] and peri- toneal solute transport using a standard peritoneal equili- bration test (PET). ♦ Methods: TGFβ1, bFGF, VEGF, and IL-6 were measured with ELISA, CRP was assayed with immunonephelometry, and fibrinogen with Multifibren U reagent (Dade Behring Marburg GmbH, Marburg, Germany). Nephron 97 for Win- dows software was used to assess dialysis adequacy. ♦ Results: Significant positive correlations between plasma bFGF and IL-6, as well as fibrinogen concentra- tions (R = 0.36, p < 0.05 and R = 0.39, p < 0.05, respec- tively), were found. VEGF correlated significantly with IL-6 and CRP (R = 0.65, p < 0.0001 and R = 0.51, p < 0.005, re- spectively). An association between VEGF and bFGF was also found (R = 0.59, p < 0.0005). Serum level of TGFβ1 revealed no relationship with any marker of acute-phase activation, remaining growth factors, or dialysis adequacy. Positive correlation between TGFβ1 concentration and di- alysate-to-plasma ratio for creatinine in PET (R = 0.35, p < 0.05) was found. In addition, patients with lower solute transport (low/low-average transporters) had lower serum levels of both bFGF and TGFβ1 compared to patients with higher solute transport. Patients with total wCCr > 60 L/ week/m 2 were characterized by lower levels of bFGF and IL-6. Serum level of IL-6 and plasma levels of bFGF and VEGF were significantly lower among subjects with re- sidual renal function (RRF) > 2.0 mL/minute. ♦ Conclusions. Our results indicate that systemic inflam- mation in peritoneal dialysis patients is associated with increased plasma VEGF and bFGF but not TGFβ1. The negative correlation with RRF suggests that either the renal clearance of these cytokines and growth factors may contribute to their elimination, or cytokines and growth factors have a negative impact on RRF. We also suggest an association between serum levels of growth factors tested and peritoneal membrane function. Perit Dial Int 2002; 22:670–676 www.PDIConnect.com KEY WORDS: Growth factors; acute-phase re- sponse; residual renal function. A ccording to current concepts, chronic renal fail- ure may be considered a chronic inflammatory state (1), as evidenced by elevated serum levels of se- lected cytokines and/or acute-phase reactants. Chronic inflammation may, in turn, lead to serious complica- tions of uremia, such as malnutrition or progression of atherosclerosis (2–8). Growth factors are also in- volved in many pathological processes in the course of chronic renal failure, such as atherogenesis, vessel wall remodeling, and, particularly, stimulation of intersti- tial kidney fibrosis with subsequent loss of renal func- tion and progression of renal insufficiency (9–17). It has been suggested recently that local intraperito- neal release of growth factors [transforming growth by guest on January 28, 2016 http://www.pdiconnect.com/ Downloaded from