Introduction: PERITONEAL DIALYSIS (PD) and hemoDIALYSIS are treatment options as renal replacement therapies for end-stage renal disease patients. Switching between PD and hemoDIALYSIS occurs due to several reasons. In the present study, we aimed at evaluating the causes of stopping PD and switching to hemoDIALYSIS.Methods: We analyzed the data of Iranian PD registry and retrospectively investigated PD patients of five PD centers in Iran. All patients who had spent at least three months on PD were included.Results: A total of 780 patients with mean age of 50.8 years were under follow up of these centers.They were all on chronic ambulatory PD with no cases of automated PD.428 patients were female (54%). Five hundred forty five patients (70%) were put on PD from the beginning, while 235 (30%) were switched from hemoDIALYSIS to PD, with 91 of them (38%) had underwent 6 or more sessions of hemoDIALYSIS. PD as the first line of RRT was selected in 79% (positive selection). Switching from PD to hemoDIALYSIS occurred in 121 patients (15%).The reasons for that were peritonitis (n=62, 51%), mechanical problems (n=19, 16%), PD failure (n=18, 15%), catheter dysfunction (n=8, 6%), and the patients’ decision (n=3, 2%).Conclusions: Peritonitis contributes to most cases of withdrawal from PD to hemoDIALYSIS. Reduction of the peritonitis rate with appropriate measures could decrease the rate of withdrawal from PD.

Introduction: Cancer Antigen 125 (CA125) level in dialysate effluent is a marker of mesothelial cell mass in stable PERITONEAL DIALYSIS (PD) patients and declines with duration of PD. Heparin also has anti–inflammatory effect, and may reduce the deleterious effects of PERITONEAL DIALYSIS solutions on mesothelial cells. The aim of this study was to evaluate the effect of heparin on prevention of mesothelial cell loss by measuring CA125, a marker of mesothelial cell mass.Methods: In a double blind randomized clinical trial, 74 Adult Continuous Ambulatory PERITONEAL DIALYSIS (CAPD) patients were enrolled the study and divided into two groups, each group contained 37 patients. The first group received 5000 units intraPERITONEAL (IP) heparin daily added to dialysate and the second group received IP distilled water daily as placebo. Patients were followed for 9 months and effluent CA125 level was measured by ELISA method, before the study, 4.5 months and after 9 months. Patients should not have used heparin more than one time per week before the study and should not have had peritonitis during the month before the study or during the study, otherwise, they exit. The data were analyzed by ttest, chi-square and repeated measure ANOVA.Results: The mean effluent CA125 levels were 17 ± 19 U/mL and 18 ± 20 U/mL (at the beginning), 15 ± 10 U/mL and 20 ± 30 U/mL (after 4.5 months), and 7 ± 11 U/mL and 8 ± 10 U/mL (at the end of the study) in the heparin and placebo group, respectively. CA125 changes was not significant between groups (P=.58), but was significant within groups (P<.001). There was not any relationship between CA125 level and age, sex, cause of renal failure, and duration of PERITONEAL DIALYSIS (P>.05).Conclusions: We did not find any relationship in CA125 effluent level between patients using IP heparin or placebo, however, IP CA125 level was decreased in both groups, which may indicate that heparin has no effects on mesothelial cell mass as shown by CA125 level. Time on DIALYSIS causes chronic injury to PERITONEAL mesothelial cells and less production of CA125 by these cells.

PERITONEAL DIALYSIS is a method of renal replacement therapy in patients with end-stage chronic renal failure. Over time, PERITONEAL DIALYSIS damages the PERITONEAL membrane, which can adversely affect PERITONEAL function, leading to cessation of PERITONEAL DIALYSIS and the onset of hemoDIALYSIS, and even malnutrition and death. Due to the invasive nature of PERITONEAL biopsy to evaluate PERITONEAL injury and fibrosis, the structure of the PERITONEAL membrane is evaluated based on biomarkers that are secreted by the PERITONEAL membrane and measured in the PERITONEAL DIALYSIS effluent. Several biomarkers were studied for this purpose, including interleukin-6, hyaluronan, vascular endothelial growth factor and etc. One of these markers is CA125 antigen, which is considered as a measure of the health and mass of mesothelial cells lining the peritoneum, which, unlike other biomarkers named above, is not secreted by any cell other than mesothelial cells. CA125 is a glycoprotein produced by ovarian cancer cells and is widely used for ovarian cancer screening today. This antigen is also secreted by mesothelial cells lining the PERITONEAL membrane and can be measured in PERITONEAL DIALYSIS effluent. Its amount is not affected by the type of DIALYSIS solution. Visser et al. (1995) first proposed the theory of measuring CA125 levels of DIALYSIS fluid at the end of a four-hour PERITONEAL equilibration test (PET) as a diagnostic biomarker for mesothelial cell function in patients undergoing PERITONEAL DIALYSIS. Therefore, finding a suitable diagnostic biomarker for rapid detection and identification of PERITONEAL membrane damage as well as PERITONEAL function at a lower cost is very valuable and will be of great help in patient management. In this review article, 25 studies with a total of 623 patients over 18 years old and 73 patients under 18 years old undergoing PERITONEAL DIALYSIS were reviewed and summarized. These 25 studies included clinical trials, descriptive studies, and prospective studies to evaluate the relationship between CA125 DIALYSIS effluent and PERITONEAL function and to evaluate the value of using this biomarker in evaluating mesothelial cell health and DIALYSIS quality and its relationship with peritonitis and demographic characteristics. Patients were evaluated and summarized. Normal baseline values for CA125 DIALYSIS concentration have not yet been determined. To date, numerous studies have been performed on PERITONEAL DIALYSIS patients in both age groups of children and adults to determine the concentration of CA125 in DIALYSIS effluent. In these studies, the level of CA125 DIALYSIS had a wide distribution range between 0. 5-65 U / ml and values CA125-AR U / min / 1. 73m2 was variable 3. 471-6. Due to the fact that CA125 DIALYSIS levels in patients are significantly different, its serial measurement in each individual may be a more valuable indicator in the follow-up of specific patients, so that deviation from the process of time reduction can be a worrying sign. Significant difference between CA125 and CA125-AR peripheral concentrations (CA-125 Apearrance rate) with patients' demographic information including age, sex, BMI (Body mas index), primary biopsy results and cause of chronic renal failure leading to DIALYSIS Not seen in various studies. Degradation of the mesothelium over time due to contact with high concentrations of PERITONEAL DIALYSIS solution, toxicity of glucose metabolites, and the occurrence of peritonitis may explain the decrease in CA125 DIALYSIS concentration. PERITONEAL biopsy data show loss of mesothelial layer integrity after 5 years in patients undergoing PERITONEAL DIALYSIS. It is a gradual process, so its changes over time can be an indication of mesothelial cell mass. This can be used in the longitudinal follow-up of rolling patients. Information on the relationship between CA125 concentration and PERITONEAL transport is somewhat inconsistent. Only in three papers a positive correlation between CA125 DIALYSIS level and PERITONEAL transport parameters was reported (11, 14, 15) and no similar correlation was seen in other studies. DIALYSIS levels of CA125 are temporarily increased during peritonitis and return to the level of patients without peritonitis after recovery. Due to the fact that the increase in CA125 concentration in the acute peritonitis episode occurs due to both reversible damage to mesothelial cells and cell death, it can not have a prognostic effect in patients with acute peritonitis. Despite more than 30 years of initial research introducing CA125 as a biomarker of the mesothelial mass of the PERITONEAL membrane, many of the results are still contradictory and a full understanding of the biological significance of this biomarker has not yet been established. Changes in its level in each person are unique and valuable over time, and further studies are needed in this regard.

Approximately, 10% to 15% of patients with end-stage renal disease are on PERITONEAL DIALYSIS (PD) worldwide, with a dramatic difference in the use of PD among various countries. Recent data show a survival benefit of PD over hemoDIALYSIS which is maintained up to the 3rd year. The quality of life studied by various models is as good as, if not better than, that in patients on hemoDIALYSIS, for at least the first 2 years. In most countries that locally manufacture PD solutions, PD is significantly cheaper than hemoDIALYSIS. Several studies have found a better immediate graft function, lower rate of delayed graft function, and lower use of immunosuppressive medication after kidney transplantation in patients previously on PD compared to those on hemoDIALYSIS. There is a significantly lower rate of hepatitis C and hepatitis B infections in patients on PD compared to those on hemoDIALYSIS. Longer maintenance of residual renal function in PD compared to hemoDIALYSIS adds to the lower morbidity and the survival benefit of PD mentioned above. Many developments in the prevention of the causes of technique failure, including measures to prevent serious peritonitis episodes and new biocompatible PD solutions, together with the possible advantages of some types of catheters and implantation techniques, encourage us to believe that we can offer successful long-term PD in the near future. Overall, the new insight into the pathogenesis of PERITONEAL membrane changes, the response of the industry to this knowledge by producing new biocompatible PD solutions, the decrease in the peritonitis rate and the introduction of assisted PD at home encourages us to believe that the future of PD is indeed bright.

Introduction: As evaluation of PERITONEAL membrane function is important in prescribing and choosing the kind of PERITONEAL DIALYSIS and probability of difference in PERITONEAL membrane characteristics among patients belonging to different geographical areas and different ethnic origin, also the possible impact of the type of transportation on patient survival, we used PERITONEAL equilibration test (PET) to determine the kind of PERITONEAL membrane transportation at the start of DIALYSIS. Materials and Methods: Forty CAPD (continuous ambulatory PERITONEAL DIALYSIS)patients, (30 males and10 females, with a mean age of 38 ± 14 years) attending Ghaem hospital, Mashhad, Iran, between October 2004 and October 2018, entered in to this study and underwent a 4. 25% glucose, PET test. Results: The obtained result showed that about 90% of patients were high or high average transporters. The results were completely different from the results reported from other world’ s PERITONEAL DIALYSIS centers, which have reported between 35 to 55 percent of high or high average transporters among chronic PERITONEAL DIALYSIS patients. Using a glucose correction factor formula, proposed by Twardowski, about thirty years ago, which only partially resolves the accuracy and precision problems, is the probable cause of this disparity. Conclusion: In our center, about 90% of chronic PERITONEAL DIALYSIS patients on CAPD, at the start of DIALYSIS, were high or high average transporters. These results are in complete discordance with results reported in medical literature or from other parts of the world. Using an outdated, glucose correction factor, with significant residual error may be the source of this discrepancy.