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The Association of Effluent Ca125 with Peritoneal Dialysis Technique Failure
Deirisa Lopes Barreto1, Tiny Hoekstra2, Nynke Halbesma2
1Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands D.LopesBarreto@amc.uva.nl.
Unlabelled:
♦
Background And Objectives:
Cancer antigen 125 (CA125) reflects the mesothelial cell mass lining the peritoneal membrane in individual patients. A decline or absence of mesothelial cells can be observed with duration of peritoneal dialysis (PD) therapy. Technique failure due to peritoneal membrane malfunction becomes of greater importance after 2 years of PD therapy in comparison to the initial period. In this study, we aimed to investigate the association between effluent CA125 and technique survival in incident PD patients with a PD therapy period of at least 2 years. ♦
Methods:
Within the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a Dutch multicenter cohort including 2,000 incident dialysis patients, we identified all PD patients who developed technique failure after 2 years of PD therapy and randomly selected a number of them as cases in a nested case-control study. Controls were PD patients matched on follow-up time without technique failure. Cases and controls were included if they had a dialysate specimen available within 24 ± 6 months of PD therapy for retrospective CA125 determinations. Odds ratios for technique failure related to CA125 were estimated. We used a prospective cohort with incident PD patients from the Academic Medical Center-University of Amsterdam (AMC) for replication of effect estimates. In these patients, absolute risk of technique failure was estimated and related to effluent CA125 levels. ♦
Results:
A total of 38 PD patients were selected from the NECOSAD cohort. From the AMC cohort as replication cohort, 91 PD patients were included. Incidence rates of PD technique failure per 100 patient-years were 16.3 in the NECOSAD cohort and 12.9 in the AMC cohort. In both study populations CA125 levels below 12 - 14 kU/L were associated with an increased risk for technique failure. Technique survival rates in the AMC were 87% in patients with levels of CA125 above 12.1 kU/L and 65% for those with CA125 levels below this threshold after a maximum 5-year follow-up. ♦
Conclusions:
Patients with high CA125 levels after at least 2 years of PD therapy tend to have better technique survival than patients with low CA125 levels. These results support the importance of effluent CA125 as a risk factor for dropout in long-term PD therapy.
Insights
High levels of cancer antigen 125 (CA125) in peritoneal dialysis (PD) effluent after two years indicate better technique survival. Low CA125 levels are associated with increased risk of technique failure in long-term PD patients.
Area of Science:
- Nephrology
- Peritoneal Dialysis
- Biomarkers
Background:
- Cancer antigen 125 (CA125) reflects peritoneal membrane health in patients undergoing peritoneal dialysis (PD).
- Mesothelial cell mass declines with PD duration, potentially leading to technique failure after two years.
- Peritoneal membrane malfunction is a significant concern for long-term PD therapy.
Purpose of the Study:
- To investigate the association between effluent CA125 levels and technique survival in incident PD patients.
- To determine if CA125 can predict technique failure after at least two years of PD therapy.
Main Methods:
- A nested case-control study within the NECOSAD cohort identified PD patients with technique failure after two years.
- Controls were matched PD patients without technique failure, with available dialysate specimens for CA125 analysis.
- A prospective cohort from AMC was used for replication, estimating absolute risk of technique failure related to effluent CA125.
Main Results:
- In both NECOSAD and AMC cohorts, CA125 levels below 12-14 kU/L were linked to a higher risk of technique failure.
- In the AMC cohort, technique survival rates were 87% for patients with CA125 >12.1 kU/L versus 65% for those with CA125 <12.1 kU/L after five years.
- Incidence rates of PD technique failure were 16.3/100 patient-years (NECOSAD) and 12.9/100 patient-years (AMC).
Conclusions:
- Elevated effluent CA125 levels after two years of PD therapy correlate with improved technique survival.
- Low CA125 levels serve as a significant risk factor for technique failure in long-term PD patients.
- Effluent CA125 is a valuable biomarker for predicting dropout risk in extended PD therapy.
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