Exfoliated Mesothelial Cell and CA-125 in Automated Peritoneal Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Talerngsak Kanjanabuch MD*,**, Nopadol Puttipittayathorn MD*,****, Asada Leelahavanichkul MD*,***, Songkiat Lieusuwan MD*, Pisut Katavetin MD*, Nanta Mahatanan RN*, Kanda Sriudom RN*****, Thanit Chirananthavat MD******, Nisa Thongbor RN*******, Somchai Eiam-Ong MD*
Affiliation : * Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand ** Kidney and Metabolic Disorders Research Center, Bangkok, Thailand *** Division of microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand **** Chiang Rai regional Hospital, Chiang Rai, Thailand ***** CAPD Service and Training, Banphaeo Hospital (Public Organization), Bangkok, Thailand ****** Police General Hospital, Bangkok, Thailand ******* Sappasit Hospital, Ubon Ratchathani, Thailand
Objective : Automated peritoneal dialysis (APD) becomes the first option for peritoneal dialysis, nowadays overtaking
continuous ambulatory peritoneal dialysis (CAPD) in many countries. The comparison of peritoneal membrane alteration in
CAPD and APD is inconclusive. The authors therefore compared the peritoneal membrane changes in patients undergoing
CAPD and APD.
Material and Method: In naive end stage renal disease patients, the choice of PD modes (CAPD or APD) was dependent on
the patient’s decision. Thirty-six CAPD and 25 APD patients with a total of 287 patient-months were compared. The peritoneal
mass parameter, exfoliated mesothelial cell (MTC) and dialysate CA-125, as well as modified peritoneal equilibrium test
(mPET) with 4.25% dextrose solution was simultaneously evaluated at 1 and 6 month follow-up.
Results : Although the peritoneal function (as measured by D/P creatinine, D/D0 glucose, sodium dipping, and dialysate
protein loss), adequacy, serum albumin, nutritional status, and residual renal function showed no significant differences
between groups at 1 and 6 months, CA-125 but not MTC was higher in APD compared with CAPD at the first month of PD
beginning. Due to the single time-point measurement limitation, the authors compared the peritoneal mass parameter
differences between 1 and 6 month. During 6-month follow-up, CA-125 decreased 30 + 5% vs. 7 + 5% and MTC decreased
5 + 12% vs. 40 + 11% in APD and CAPD, respectively. The higher CA-125 reduction in APD and greater changes of MTC
in CAPD suggested that there was less viable mesothelial cell in APD compared with CAPD.
Conclusion : The authors observed that both APD and CAPD damaged peritoneum. However, there might be higher
peritoneal injury in APD patients. The proper randomization study in longer follow-up period is mandatory to confirm this
observation.
Keywords : CAPD, APD, Mesothelial cell mass, CA-125, Exfoliated mesothelial cell
