Hyaluronic acid metabolism and its clinical significance in patients treated by continuous ambulatory peritoneal dialysis.

Musculoskeletal syndromes are common in patients treated by dialysis for end-stage renal failure and abnormal connective tissue metabolism has been implicated. Hyaluronic acid is a major component of connective tissue ground substance. Serum, dialysate, and 24-h urine hyaluronic acid was therefore measured in 43 patients treated by CAPD to determine hyaluronic acid metabolism and to relate these variables to morbidity and mortality over an 18-month period. Serum hyaluronic acid was elevated in 71% patients, being correlated with patient age, length of time on dialysis, and weight loss over the preceding 6 months. Small quantities of predominantly low-molecular-weight hyaluronic acid were lost in the urine, whereas much larger amounts of mixed-molecular-weight hyaluronic acid were excreted in peritoneal dialysate. Dialysate hyaluronic acid exceeded serum hyaluronic acid. Baseline serum hyaluronic acid was closely correlated with morbidity and mortality over the following 18 months. Serum hyaluronic acid is an accurate predictor of mortality and morbidity over an 18-month period in patients treated by CAPD. Large quantities of hyaluronic acid are excreted in peritoneal dialysate, which in part represents local hyaluronic acid production.