Frontotemporal lobar degeneration
David Neary, Julie S. Snowden, Lars Gustafson, Ulla Passant, Donald T. Stuss, Sandra E. Black, Morris Freedman, ANDREW E. KERTESZ, P.H. Robert, Keith W. Boone, Bruce L. Miller, Jeffrey L. Cummings, D. Frank Benson
Neurology · 1998 · 5,102 citations
Abstract
Abstract. In long-term peritoneal dialysis, functional deterioration of the peritoneal membrane is often associated with proliferative processes of the involved tissues leading to peritoneal fibrosis. In continuous ambulatory peritoneal dialysis (CAPD), failure to achieve target values for adequacy of dialysis is commonly corrected by increasing dwell volume; in case of ultrafiltration failure, osmolarity of the dialysate gets increased. In a prospective study, the impact of increasing dwell volume from 1500 ml to 2500 ml per dwell (volume trial) or changing the osmolarity of the dialysate from 1.36 to 3.86% glucose (hyperosmolarity trial) on the peritoneal endothelin-1 (ET-1) release was analyzed. ET-1 is known to exert significant proliferative activities on a variety of cell types leading to an accumulation of extracellular matrix. A highly significant difference in the cumulative peritoneal ET-1 synthesis was found between the low- and high-volume exchange, whereas differences in the hyperosmolarity setting were only moderate. Sixty minutes after initiating dialysis, the cumulative ET-1 synthesis was 2367 ± 1023 fmol for the 1500 ml versus 6062 ± 1419 fmol for the 2500 dwell (P < 0.0001) and 4572 ± 969 fmol versus 6124 ± 1473 fmol for the 1.36 and 3.86% glucose dwell (P < 0.05), respectively. In conclusion, increasing dwell volume leads to a strong activation of the peritoneal paracrine endothelin system. Because ET-1, apart from being a potent vasoactive peptide, contributes to fibrotic remodeling, this study indicates that volume stress-induced ET-1 release might contribute to structural alteration of the peritoneal membrane in long-term peritoneal dialysis.
Cite this paper
Neary, D., Snowden, J. S., Gustafson, L., Passant, U., Stuss, D. T., Black, S. E., Freedman, M., KERTESZ, A. E., Robert, P., Albert, M., Boone, K. W., Miller, B. L., Cummings, J. L., & Benson, D. F. (1998). Frontotemporal lobar degeneration. Neurology, 51(6), 1546–1554. https://doi.org/10.1212/wnl.51.6.1546
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