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For Peer Review Only Journal: BMJ Open BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-012967 on 26 October 2016. Downloaded from Possible role of IL-6 and TIE2 gene polymorphisms in predicting the initial high transport status in peritoneal dialysis patients: an observational study For peer review only Journal: BMJ Open Manuscript ID bmjopen-2016-012967 Article Type: Research Date Submitted by the Author: 14-Jun-2016 Complete List of Authors: Ding, Li ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Shao, Xinghua ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Cao, Liou ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Fang, Wei; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Yan, Hao ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Huang, Jiaying ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Gu, Aiping ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology http://bmjopen.bmj.com/ Yu, Zanzhe ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Qi, Chaojun ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Chang, Xinbei ; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology Ni, Zhaohui; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China, Department of Nephrology on September 27, 2021 by guest. Protected copyright. <b>Primary Subject Urology Heading</b>: Secondary Subject Heading: Urology, Renal medicine peritoneal dialysis, high transport status, interleukin-6, TIE2, gene Keywords: polymorphism For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 23 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-012967 on 26 October 2016. Downloaded from 1 2 3 Possible role of IL-6 and TIE2 gene polymorphisms in predicting the initial high 4 5 transport status in peritoneal dialysis patients: an observational study 6 7 Li Ding1,#, Xinghua Shao1,#, Liou Cao1, Wei Fang1, Hao Yan1, Jiaying Huang1, Aiping Gu1, 8 9 1 1 1 1, 10 Zanzhe Yu , Chaojun Qi , Xinbei Chang , Zhaohui Ni * 11 1 12 Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong 13 14 University, Shanghai 200127, China 15 For peer review only 16 #The authors contributed equally to this work 17 18 19 20 * 21 Corresponding author: 22 23 Zhaohui Ni 24 25 Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong 26 27 University, No. 1630, Dongfang Road, Pudong District, Shanghai 200127, China 28 29 30 Tel: +86-021-68383121 31 32 Email: [email protected] 33 34 http://bmjopen.bmj.com/ 35 36 Running title: Role of IL-6 and TIE2 Gene Polymorphisms 37 38 39 40 41 42 on September 27, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 23 BMJ Open: first published as 10.1136/bmjopen-2016-012967 on 26 October 2016. Downloaded from 1 2 3 Abstract 4 5 Objectives: The aim of this study was to investigate the effect of IL-6 and TIE2 gene 6 7 polymorphisms on baseline peritoneal transport property. 8 9 10 Design: An observational study 11 12 13 Setting: A hospital. 14 15 Participants:For This study peer included 220 review continuous ambulatory only peritoneal dialysis (PD) 16 17 patients. 18 19 20 Outcome measures: Patients were divided into two groups based on the results of an initial 21 22 peritoneal equilibration test performed within 3 months of starting PD therapy: group 1 23 24 consisted of low/low average transporters (n = 123), and group 2 consisted of high/high 25 26 27 average transporters (n = 97). We genotyped TIE2 and IL-6 polymorphisms and analysed 28 29 their effects on baseline transport status. 30 31 Results: The genotype AT in IL-6 Rs13306435 and the genotype CC in TIE2 Rs639225 were 32 33 both negatively associated with a higher initial peritoneal transport status (IL-6 Rs13306435: 34 http://bmjopen.bmj.com/ 35 36 OR = 0.408, 95% CI, 0.227~0.736; TIE2 Rs639225: OR = 0.188, 95% CI, 0.044~0.806). 37 38 Conclusions: IL-6 and TIE2 polymorphisms are associated with baseline peritoneal transport 39 40 property. 41 42 on September 27, 2021 by guest. Protected copyright. 43 44 Keywords: peritoneal dialysis, high transport status, interleukin-6, TIE2, gene polymorphism 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 2 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 23 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-012967 on 26 October 2016. Downloaded from 1 2 3 Article summary 4 5 Strengths of this study 6 7 This study was the first study exploring the possible association between TIE2 gene 8 9 10 polymorphisms and the characteristics of peritoneal transport. 11 12 This study confirmed the association between IL-6 polymorphism and baseline peritoneal 13 14 transport among the Chinese Han population. 15 For peer review only 16 This study may provide a convenient and non-invasive method to determine transport status 17 18 19 before starting dialysis. 20 21 This study may be helpful in improving the prognosis of ESRD patients. 22 23 This study may help us elucidate the mechanisms underlying high transport status. 24 25 26 27 Limitations of this study 28 29 30 The TA genotype of rs13306435 presents in only 7% of the total population; therefore, it is 31 32 not the main determinant of peritoneal transport in most patients. 33 34 This study was a single center research. http://bmjopen.bmj.com/ 35 36 This study needs to be improved by increasing the sample size. 37 38 39 We did not examine dialysate IL-6/TIE2 concentration to investigate its relationship with 40 41 SNPs. 42 on September 27, 2021 by guest. Protected copyright. 43 We found no statistically significant difference in the data of D/P creatinine and D/D0 44 45 glucose among different genotypes. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 3 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 23 BMJ Open: first published as 10.1136/bmjopen-2016-012967 on 26 October 2016. Downloaded from 1 2 3 Introduction 4 5 Peritoneal dialysis (PD) is an effective renal replacement therapy for end stage renal disease 6 7 (ESRD) patients1. Patients undergoing peritoneal dialysis have significantly different small 8 9 10 solute transport rates. The standard peritoneal equilibration test (PET) proposed by 11 12 Twardowski in 1987 is the most widely used method to assess the peritoneal small solute 13 14 transport rate2. Patients can be divided into four types: high (H), high-average (HA), 15 For peer review only 16 low-average (LA), and low (L) based on PET results. Studies have shown an association 17 18 3-6 7 19 between high transport status and poor outcome . Results of meta-analysis have indicated 20 21 that for every 0.1 increase in the dialysate over plasma ratio for creatinine (D/P Cr), the 22 23 relative risks for mortality and technique failure increase by 1.15 and 1.18, respectively. 24 25 Compared with that of the low transport group, the mortality of the low-average, 26 27 high-average, and high transport groups increased by 21.9%, 45.7%, and 77.3%, respectively. 28 29 8-11 30 As technology advances, new peritoneal dialysate (icodextrin) and automated peritoneal 31 12-14 32 dialysis (APD) have been shown to improve the prognosis of high transporters. However, 33 34 in developing countries, icodextrin and APD cannot be widely used for PD patients. Initial http://bmjopen.bmj.com/ 35 36 high transport is still an important factor that influences the outcome of these patients without 37 38 39 icodextrin or APD. Therefore, it is important to know the baseline peritoneal transport 40 41 property before starting PD therapy. We can advise probable high transporter patients to 42 on September 27, 2021 by guest. Protected copyright. 43 choose haemodialysis (HD) or renal transplantation for renal replacement therapy. 44 45 Researchers have attempted to find non-invasive biomarkers to predict the baseline peritoneal 46 47 membrane function before starting dialysis. Previous studies found that age, gender, and 48 49 50 complications such as hypertension, diabetes, and malnutrition might influence transport 51 1 52 characteristics . However, they are not sufficient to predict high transport status. 53 54 In recent years, many studies have shown that genetic variants may play an important role in 55 56 mechanisms contributing to the baseline variability in peritoneal transport15-20. It has been 57 58 59 4 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 23 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2016-012967 on 26 October 2016. Downloaded from 1 2 3 suggested that chronic inflammation mediated by various inflammatory cytokines may have 4 5 an effect on peritoneal transport21. Studies have shown that the IL-6 level in peritoneal 6 7 dialysates is associated with the peritoneal solute transport rate in dialysis patients22-24.
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