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. 2022 Aug 10:9:836861.
doi: 10.3389/fmed.2022.836861. eCollection 2022.

High intraperitoneal interleukin-6 levels predict ultrafiltration (UF) insufficiency in peritoneal dialysis patients: A prospective cohort study

Qianhui Song  1   2 , Xiaoxiao Yang  1   2 , Yuanyuan Shi  1   2 , Hao Yan  1   2 , Zanzhe Yu  1   2 , Zhenyuan Li  1   2 , Jiangzi Yuan  1   2 , Zhaohui Ni  1   2 , Leyi Gu  1   2 , Wei Fang  1   2
Affiliations

High intraperitoneal interleukin-6 levels predict ultrafiltration (UF) insufficiency in peritoneal dialysis patients: A prospective cohort study

Qianhui Song et al. Front Med (Lausanne). .

Abstract

Introduction: UF insufficiency is a major limitation in PD efficiency and sustainability. Our study object to investigate the efficacy of intraperitoneal inflammation marker, IL-6 level as a predictor of UF insufficiency in continuous ambulatory peritoneal dialysis (CAPD) patients.

Methods: Stable prevalent CAPD patients were enrolled in this prospective study. IL-6 concentration in the overnight effluent was determined and expressed as the IL-6 appearance rate (IL-6 AR). Patients were divided into two groups according to the median of IL-6 AR and prospectively followed up until death, transfer to permanent HD, recovery of renal function, kidney transplantation, transfer to other centers, lost to follow-up or to the end of study (January 31, 2021). Factors associated with UF capacity as well as dialysate IL-6 AR were assessed by multivariable linear regression. Cox proportional hazards model was used to examine the association between dialysate IL-6 AR and UF insufficiency.

Results: A total of 291 PD patients were enrolled, including 148 males (51%) with a mean age of 56.6 ± 14.1 years and a median PD duration of 33.4 (12.7-57.5) months. No correlation was found between dialysate IL-6 AR and UF capacity at baseline. PD duration was found positively correlated with baseline dialysate IL-6 AR, while 24h urine volume was negatively correlated with baseline dialysate IL-6 AR (P < 0.05). By the end of study, UF insufficiency was observed in 56 (19.2%) patients. Patients in the high IL-6 AR group showed a significantly inferior UF insufficiency-free survival when compared with their counterparts in the low IL-6 AR group (P = 0.001). In the multivariate Cox regression analysis, after adjusting for DM, previous peritonitis episode and 24h urine volume, higher baseline dialysate IL-6 AR (HR 3.639, 95% CI 1.776-7.456, P = 0.002) were associated with an increased risk of UF insufficiency. The area under the ROC curve (AUC) for baseline IL-6 AR to predict UF insufficiency was 0.663 (95% CI, 0.580-0.746; P < 0.001).

Conclusion: Our study suggested that the dialysate IL-6 AR could be a potential predictor of UF insufficiency in patients undergoing PD.

Keywords: inflammation; interleukin-6; peritoneal dialysis; ultrafiltration capacity; ultrafiltration insufficiency.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient inclusion in analysis. AR, appearance rate.
Figure 2
Figure 2
Longitudinal changes in UF capacity for the whole cohort (A), low IL-6 AR group (B), and high IL-6 AR group (C). Values expressed as trajectories of UF capacity for each single patient with an overlay of mean curves. UF, ultrafiltration; AR, appearance rate.
Figure 3
Figure 3
Dialysate IL-6 AR level in patients with or without UF insufficiency (***p < 0.001). Non-parametric data were compared using Mann–Whitney test. UF, ultrafiltration; AR, appearance rate.
Figure 4
Figure 4
Kaplan–Meier curves by IL-6 AR for UF insufficiency-free survival. UF, ultrafiltration; AR, appearance rate.
Figure 5
Figure 5
ROC curve for dialysate IL-6 AR to predict UF insufficiency in PD patients. AR, appearance rate; UF, ultrafiltration.
See this image and copyright information in PMC

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