Hyaluronan is an important component of extracellular matrix and plays a critical role in early phases of wound healing. Peritoneal mesothelium is a major site of
hyaluronan production. Serum
hyaluronan concentration has been shown to predict survival in maintenance
hemodialysis patients. We hypothesize that mesothelial production of
hyaluronan during the stable phase of
continuous ambulatory peritoneal dialysis (
CAPD) predicts the risk of peritoneal adhesion and mortality. We studied peritoneal
dialysate effluent (PDE)
hyaluronan levels from 116 stable
CAPD patients. They were then followed-up for 3 years. During the follow-up period, there were 196 episodes of
peritonitis in 78 patients. Tenckhoff
catheter was removed in 31 episodes (15.8%). Tenckhoff
catheter was reinserted successfully in 12 cases, and
CAPD was resumed. Peritoneal adhesion developed in 16 cases. Three patients died before Tenckhoff
catheter reinsertion was attempted. There was no difference in stable-phase PDE
hyaluronan levels between patients who developed peritoneal adhesion and those who did not (159 +/- 63 versus 227 +/- 194 microgram/L, P = 0.27). Thirty-three patients died during the study period. Patients who died had significantly higher PDE
hyaluronan concentration than survivors (272 +/- 194 versus 170 +/- 105 microgram/L, P < 0.01). Univariate analysis showed that increased PDE
hyaluronan level was associated with a shorter patient survival (P < 0.001). There was no association between PDE
hyaluronan level and
serum albumin,
protein nitrogen appearance, and percentage of lean body mass. Multivariate analysis confirmed that PDE
hyaluronan level,
serum albumin, and diabetic state were independent predictors of survival. We conclude that PDE
hyaluronan level during stable phase of
CAPD does not predict the risk of postperitonitis adhesion. However, it is a strong independent predictor of survival in
CAPD patients.