Inflammation in Peritoneal Dialysis Patients: Effect of Obesity

Chronic inflammation is highly prevalent in ESRD and associated with adverse outcomes. For
example, chronic exposure of the peritoneal cavity to PD solution leads to induction of
cytokines and other inflammatory mediators, generating peritoneal membrane inflammation
which results in functional decline of ultrafiltration. Obesity is characterized by a state
of chronic low-grade systemic inflammation stemming from expanded adipose tissue mass.
Animal studies from our group and others suggest that obesity is associated with exacerbated
prolonged inflammatory responses in the peritoneal cavity. The shifting demographic
characteristics of the ESRD population, with a rise in elderly patients and those with
obesity, is as a significant challenge for management of dialysis patients. Specifically, a
2-fold increase in the percentage of obese patients in the ESRD population has been
reported. The caloric burden of PD glucose-containing solutions adds an additional risk for
development or exacerbation of obesity and diabetes in patients using this dialysis
modality. Few studies have directly evaluated the association between degree of adiposity
and inflammation in PD patients. Data obtained from the proposed experiments will help
clarify the connection between obesity and risk factors for cardiovascular and infectious
diseases in the PD population. These data will also further our knowledge of the basic
pathophysiology of both obesity and ESRD and enhance our understanding of factors involved
in successful delivery of PD. Results may lead to enhanced nutritional recommendations for
PD patients and/or the use of low-glucose or non-glucose alternatives, with a resultant
reduction in local and/or systemic inflammation and CVD and other risk factors.

Inclusion Criteria:

1. > 18 years; and

2. peritoneal dialysis (PD) > 6 months.

Exclusion Criteria:

1. infectious episode within 4 weeks; and

2. using immunosuppressive drugs