Deirisa Lopes Barreto1, Dirk G Struijk2, Raymond T Krediet3. 1. Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam. Electronic address: d.lopesbarreto@amc.uva.nl. 2. Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam; Dianet Foundation, Amsterdam-Utrecht, the Netherlands. 3. Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam.
Abstract
BACKGROUND: Recently, the use of effluent matrix metalloproteinase 2 (MMP-2) and plasminogen activator inhibitor 1 (PAI-1) as potential biomarkers of peritoneal fibrosis has been demonstrated during longitudinal follow-up of incident peritoneal dialysis (PD) patients. This study focuses on effluent MMP-2 and PAI-1 as early diagnostic markers in the preceding years of patients who develop encapsulating peritoneal sclerosis (EPS). STUDY DESIGN: Diagnostic test study. SETTINGS & PARTICIPANTS: PD patients who developed EPS were compared with controls using a 1:3 case-control design with a minimum PD duration of 57 months. INDEX TESTS: Dialysate appearance rates of MMP-2 and PAI-1. REFERENCE TEST: EPS cases identified by 2 experienced nephrologists and a radiologist based on predefined criteria. RESULTS: 11 patients developed EPS within our center. The time course of MMP-2 appearance rates, studied by means of a linear repeated-measures model 4 years prior to the diagnosis of EPS, showed no difference between long-term controls and patients with EPS. In contrast, higher PAI-1 appearance rates were found in patients with EPS compared with controls (P=0.01). At a lag time of 1 year prior to EPS diagnosis, time-specific receiver operating characteristic curve analyses indicated a discriminative ability for PAI-1 appearance rate of 0.77 (95% CI, 0.63-0.91). A discriminative capacity was absent for those of MMP-2. LIMITATIONS: Low event rate of EPS prevented independent validation in this single-center study. CONCLUSIONS: Elevated levels of PAI-1 appearance rates are present in patients who develop EPS, pointing to progressive peritoneal fibrosis and sclerosis. The PAI-1 appearance rate has fair discriminative capacity from 3 years prior to EPS diagnosis. Therefore, effluent PAI-1 may aid in monitoring peritoneal fibrosis and serve as a biomarker for EPS.
BACKGROUND: Recently, the use of effluent matrix metalloproteinase 2 (MMP-2) and plasminogen activator inhibitor 1 (PAI-1) as potential biomarkers of peritoneal fibrosis has been demonstrated during longitudinal follow-up of incident peritoneal dialysis (PD) patients. This study focuses on effluent MMP-2 and PAI-1 as early diagnostic markers in the preceding years of patients who develop encapsulating peritoneal sclerosis (EPS). STUDY DESIGN: Diagnostic test study. SETTINGS & PARTICIPANTS: PDpatients who developed EPS were compared with controls using a 1:3 case-control design with a minimum PD duration of 57 months. INDEX TESTS: Dialysate appearance rates of MMP-2 and PAI-1. REFERENCE TEST: EPS cases identified by 2 experienced nephrologists and a radiologist based on predefined criteria. RESULTS: 11 patients developed EPS within our center. The time course of MMP-2 appearance rates, studied by means of a linear repeated-measures model 4 years prior to the diagnosis of EPS, showed no difference between long-term controls and patients with EPS. In contrast, higher PAI-1 appearance rates were found in patients with EPS compared with controls (P=0.01). At a lag time of 1 year prior to EPS diagnosis, time-specific receiver operating characteristic curve analyses indicated a discriminative ability for PAI-1 appearance rate of 0.77 (95% CI, 0.63-0.91). A discriminative capacity was absent for those of MMP-2. LIMITATIONS: Low event rate of EPS prevented independent validation in this single-center study. CONCLUSIONS: Elevated levels of PAI-1 appearance rates are present in patients who develop EPS, pointing to progressive peritoneal fibrosis and sclerosis. The PAI-1 appearance rate has fair discriminative capacity from 3 years prior to EPS diagnosis. Therefore, effluent PAI-1 may aid in monitoring peritoneal fibrosis and serve as a biomarker for EPS.
Authors: Christine-Maria Horejs; Jean-Philippe St-Pierre; Juha R M Ojala; Joseph A M Steele; Patricia Barros da Silva; Angela Rynne-Vidal; Stephanie A Maynard; Catherine S Hansel; Clara Rodríguez-Fernández; Manuel M Mazo; Amanda Y F You; Alex J Wang; Thomas von Erlach; Karl Tryggvason; Manuel López-Cabrera; Molly M Stevens Journal: Nat Commun Date: 2017-06-08 Impact factor: 14.919
Authors: Marta Ossorio; María Auxiliadora Bajo; Gloria Del Peso; Virginia Martínez; María Fernández; María José Castro; Aranzazu Rodríguez-Sanz; Rosario Madero; Teresa Bellón; Rafael Selgas Journal: PLoS One Date: 2017-04-17 Impact factor: 3.240