Document Detail

Intraperitoneal IL-6 signaling in incident patients treated with icodextrin and glucose bicarbonate/lactate-based peritoneal dialysis solutions.
MedLine Citation:
PMID:  22302924     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: In this study, we compared the activity of interleukin-6 (IL-6), a marker of ongoing peritoneal inflammation and biocompatibility, and its other signaling components, the soluble IL-6 receptor (sIL-6R) and soluble Gp130 (sGp130), in peritoneal effluent from patients treated with icodextrin-based (E) peritoneal dialysis (PD) solution and glucose-based bicarbonate/lactate-buffered (P) solution.
METHODS: Using baseline peritoneal ultrafiltration capacity, 33 stable incident PD patients were allocated either to P only (n = 20) or to P plus E for the overnight dwell (n = 13). We used ELISA to determine IL-6, sIL-6R, and sGp130 in timed overnight effluent at 1, 6, and 12 months after PD initiation. Flow cytometry was used to measure expression of IL-6R and Gp130 on isolated peritoneal leukocytes at the same time points. Peritonitis was an exclusion criterion.
RESULTS: At all time points, levels of IL-6 and sIL-6R, and the appearance rates of IL-6 (90.5 pg/min vs. 481.1 pg/min, p < 0.001; 138.6 pg/min vs. 1187.5 pg/min, p < 0.001; and 56.1 pg/min vs. 1386.0 pg/min, p < 0.001), sIL-6R (2035.3 pg/min vs. 4907.0 pg/min, p < 0.01; 1375.0 pg/min vs. 6348.4 pg/min, p < 0.01; and 1881.3 pg/min vs. 5437.8 pg/min, p < 0.01), and sGp130 (37.6 ng/min vs. 65.4 ng/min, p < 0.01; 39.2 ng/min vs. 80.6 ng/min, p < 0.01; 27.8 ng/min vs. 71.0 ng/min, p < 0.01) were significantly higher in peritoneal effluent from E-treated patients than from P-treated patients. Expression of IL6-R and Gp130 on individual leukocyte types isolated from PD effluent did not differ between E- and P-treated patients. The numbers of white blood cells present in effluent were higher in E-treated than in P-treated patients at all time points, but no significant differences were seen in the differential counts or in the number of exfoliated mesothelial cells. The IL-6 parameters in effluent from E-treated patients correlated with their plasma C-reactive protein. Despite the increased activation of the IL-6 system, no increase in peritoneal permeability as assessed by the dialysate-to-plasma ratio of creatinine in E effluent or by systemic inflammation was observed throughout the study.
CONCLUSIONS: Higher levels of IL-6, its soluble receptors, and leukocyte expression were observed in E-treated than in P-treated patients, but this difference was not associated with alterations in peritoneal permeability or systemic inflammation during 1 year of follow-up. Leukocyte counts in effluent from E-treated patients were within the normal range previously reported for glucose solutions. This lack of clinical consequences may be a result of a parallel rise in sIL-6R and sGp130, which are known to control the biologic activity of IL-6. The utility of IL-6 level determinations, in isolation, for assessing the biocompatibility of PD solutions is questionable.
Sylvie Opatrna; Daniel Lysak; Ladislav Trefil; Clare Parker; Nicholas Topley
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  32     ISSN:  1718-4304     ISO Abbreviation:  Perit Dial Int     Publication Date:    2012 Jan-Feb
Date Detail:
Created Date:  2012-02-03     Completed Date:  2012-07-10     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  37-44     Citation Subset:  IM    
Department of Medicine I, Charles University Medical School, Pilsen, Czech Republic.
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MeSH Terms
Bicarbonates / pharmacology*
Dialysis Solutions / pharmacology*
Drug Combinations
Enzyme-Linked Immunosorbent Assay
Flow Cytometry
Follow-Up Studies
Glucans / pharmacology*
Glucose / pharmacology*
Interleukin-6 / metabolism*
Lactic Acid / pharmacology*
Middle Aged
Peritoneal Dialysis, Continuous Ambulatory / methods*
Peritoneum / drug effects,  metabolism,  pathology
Prospective Studies
Signal Transduction
Time Factors
Young Adult
Reg. No./Substance:
0/Bicarbonates; 0/Dialysis Solutions; 0/Drug Combinations; 0/Glucans; 0/Interleukin-6; 0/icodextrin; 50-21-5/Lactic Acid; 50-99-7/Glucose

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