Effluent plasminogen activator inhibitor 1 predicts ultrafiltration in incident peritoneal dialysis patients

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Wang, Che-Yi Chou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4299168/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The peritoneal equilibration test (PET) measures ultrafiltration and small solute clearance in peritoneal dialysis (PD). We aimed to assess if PET and biomarkers predict ultrafiltration in the first two days of PD. Biomarkers included in the study were matrix metalloproteinase-2 (MMP2), plasminogen activator inhibitor 1 (PAI1), aquaporin1 (AQP1), toll-like receptor 4 (TLR4), and CA125. Methods We enrolled 36 incident PD patients, and a fast PET was performed after the PD catheter insertion. Effluent MMP2, PAI1, AQP1, TLR4, and CA125 were collected with the fast PET and were measured using commercially available ELISA kits. The association of ultrafiltration and variables was analyzed using linear regression. Results The mean age of 36 patients was 69 ± 13 years, and 22 (61.1%) patients were male. The average daily ultrafiltration was 652 ± 775 ml in the first two days of PD. The D/P creatinine 1-hour was 0.59 ± 0.21, MMP2 13.9 ± 13.1 ng/ml, and PAI1 1.59 ± 1.88 ng/ml. MMP2 (p = 0.007) and PAI1 (p < 0.001) were significantly associated with ultrafiltration in univariable linear regression, but D/P creatinine (p = 0.064) was not. PAI1, independent of MMP2 and D/P creatinine, was associated with ultrafiltration with a coefficient of 404.18 (95% confident intervals 143.85 to 664.50, p = 0.003) in multivariable linear regression. Conclusion Measurements of effluent PAI1 at the PD catheter insertion predict ultrafiltration in the first two days of PD. The association of PAI1 and ultrafiltration is independent of MMP2 and D/P creatinine using fast PET. peritoneal dialysis ultrafiltration PAI1 plasminogen activator inhibitor-1 peritoneal equilibration test PET MMP2 Figures Figure 1 Introduction High-quality peritoneal dialysis (PD) is characterized by the adequacy of ultrafiltration and small solute clearance to maintain fluid and salt homeostasis [ 1 ]. Ultrafiltration and small solute clearance are usually accessed using the peritoneal equilibration test (PET). PET is widely used to guide PD prescriptions and prognosticate [ 2 , 3 ]. The first PET is typically performed 4–8 weeks after initiation of PD [ 4 ]. PET is not used to predict ultrafiltration at the initiation of PD because PET results may change during the first month of PD [ 5 ]. We aimed to explore if PET and biomarkers at the PD catheter insertion predict ultrafiltration in the first two days of PD. We reviewed the literature and selected five potential effluent biomarkers to predict ultrafiltration. The five biomarkers are matrix metalloproteinase-2 (MMP2), plasminogen activator inhibitor 1 (PAI1) [ 6 ], aquaporin1 (AQP1) [ 7 ], toll-like receptor 4 (TLR4) [ 8 ], and CA125 [ 9 ]. MMP-2 cleaves denatured collagen and complement other collagenases in the degradation of fibrillar collagens. Elevated effluent PAI-1 is presented in patients with intra-abdominal adhesions. MMP2 and PAI1 are involved in the process of peritoneal fibrosis and may be a potential biomarker for ultrafiltration. AQP1 is expressed is expressed in endothelial cells of peritoneal capillaries and may influence water transport. TLR4 is involved in the inflammation process of peritoneal mesothelial cells. CA125 reflects the mesothelial cell mass lining the peritoneal membrane. Methods This study complied with the Declaration of Helsinki and was performed according to ethics committee approval. The study was approved by the institutional review board of China Medical University Hospital (CMUH108-REC2-080), and written informed consent was obtained from all participants. We enrolled patients based on the following inclusion criteria: at least 20 years, incident PD patients, and being able to give informed consent. The exclusion criteria were: younger than 20 years, having a history of PD, and unable to give informed consent. We enrolled 36 incident PD patients from July 2019 to June 2020. Two patients with technique failure after PD catheter insertion were excluded because no effluent was available. We performed a fast PET after PD catheter insertion; effluent samples were collected at 1 hour, and a blood sample was collected at 1 hour [ 10 ]. The 1-hour D/P ratios of creatinine were calculated in all patients. We measured effluent MMP2 (MMP2 Human ELISA Kit, Invitrogen, Catalog NO. KHC3081), PAI1(Human ELISA Kit, Invitrogen, Catalog NO. BMS2033), AQP1 (Human Aquaporin 1, AQP-1 ELISA Kit, CUSABIO, Catalog NO. CSB-E08248h), TLR4 (Human TLR-4 ELISA Kit, Invitrogen, Catalog NO. EH460RB), and CA125 (CA125 Human ELISA Kit, Invitrogen, Catalog NO. EHMUC16) following the manufacturer's instructions. Patient characteristics, including age, gender, hypertension, diabetes, primary kidney disease, height, weight, systolic blood pressure, and diastolic blood pressure, were collected at the enrollments. Body surface area was calculated as 0.007184 × height (cm) 0.725 × weight (kg) 0.425 . All patients had four exchanges of one liter of 2.5% dextrose dialysate with a 4-hour dwell for two days after PD catheter insertion. We recorded the daily ultrafiltration, and the average values were calculated. Statistical analysis Data are reported as the means (standard deviations) or frequencies (percentages) where appropriate. The association of ultrafiltration and variables was analyzed using linear regression. The variables' coefficient and 95% confidence interval (CI) were calculated. The sample size (N = 20) was calculated using Fisher's Z test based on the coefficient of PAI1 and ultrafiltration [ 6 ] with a power of 0.8 and a p-value of 0.05. All analyses were performed using R Statistical Software (version 4.2.1, R Foundation for Statistical Computing, Vienna, Austria) with finalfit packages. A p < 0.05 were considered statistically significant. Results The mean age of the 36 enrolled patients was 69 ± 13 years, and 61.1% were male (Table 1 ). Sixteen (44.4%) patients had diabetes, and 27 (75%) patients had hypertension. Diabetes was the primary kidney disease in 13 (36.1%) patients, hypertension in 13 (36.1%) patients, and chronic glomerulonephritis in 6 (16.7%) patients. The average height was 160 ± 10 cm, weight 65 ± 15 kg, and body surface area 1.67 ± 0.21 m 2 . The systolic blood pressure was 136 ± 30 mmHg, and the diastolic blood pressure was 68 ± 19 mmHg. The blood urea nitrogen was 104 ± 50 mg/dl, creatinine 9.1 ± 3.1 mg/dl, sodium 134 ± 5 meq/L, and blood glucose 202 ± 99 mg/dl. The D/D0 glucose was 0.59 ± 0.2. The effluent MMP2 was 13.9 ± 13.1 ng/ml, AQP1 4624.2 ± 3946.1 pg/ml, PAI1 1.59 ± 1.88 ng/ml, TLR4 1334.3 ± 277.9 pg/ml, and CA125 85.6 ± 58.2 IU/ml. Table 1 Characteristics of all patients Characteristics N = 36 Age (year) 69 ± 13 Male (n%) 22 61.1% Diabetes (n%) 16 44.4% Hypertension (n%) 27 75.0% Primary kidney disease Diabetes (n%) 13 36.1% Chronic glomerulonephritis (n%) 6 16.7% Hypertension (n%) 13 36.1% Other (n%) 4 11.2% Height (cm) 160 ± 10 Weight (kg) 65 ± 15 Body surface area (m 2 ) 1.67 ± 0.21 Systolic blood pressure (mmHg) 136 ± 30 Diastolic blood pressure (mmHg) 68 ± 19 Blood urea nitrogen (mg/dl) 104 ± 50 Creatinine (mg/dl) 9.1 ± 3.1 Sodium (meq/L) 134 ± 5 Glucose (mg/dl) 202 ± 99 The average daily ultrafiltration was 652 ± 775ml (Table 2 ). The D/P creatinine was 0.59 ± 0.21, D/P sodium 0.96 ± 0.03, D/P glucose 5.85 ± 3.84. The MMP2 in the effluent was 13.9 ± 13.1ng/ml, AQP1 4627.2 ± 3946.1 pg/ml, PAI1 1.59 ± 1.88 ng/ml, TLR4 1334.3 ± 277.9, and CA125 85.6 ± 58.2 IU/ml. Table 2 Daily average ultrafiltration and effluent biomarkers of all patients Parameters Mean SD Ultrafiltration (ml) 652 ± 775 D/P creatinine 0.59 ± 0.21 D/P sodium 0.96 ± 0.03 D/P glucose 5.85 ± 3.84 Effluent Creatinine (mg/dl) 5.71 ± 3.86 Sodium (meq/L) 129 ± 5.9 Glucose (mg/dl) 983 ± 317 Matrix metalloproteinase-2 (MMP2, ng/ml) 13.9 ± 13.1 Aquaporin 1 (AQP1, pg/ml) 4627.2 ± 3946.1 Plasminogen activator inhibitor-1 (PAI1, ng/ml) 1.59 ± 1.88 Toll-like receptor 4 (TLR4, pg/ml) 1334.3 ± 277.9 CA125 (IU/ml) 85.6 ± 58.2 SD: standard deviation The coefficient of D/D0 glucose was 1177.58 (95% CI:-74.11 to 2429.26, p = 0.064) in univariable linear regression (Table 3 ). The D/P sodium and D/P glucose were not associated with ultrafiltration. The blood glucose, sodium, creatine, and urea nitrogen were not significantly associated with ultrafiltration. The coefficient of effluent glucose was − 0.72 (95% CI -1.54 to 0.10, p = 0.082). The effluent creatine, sodium, and urea nitrogen were not linked to ultrafiltration. PAI1 and MMP2 were significantly associated with ultrafiltration. The coefficient of PAI1 was 252.28 (95% CI 131.88 to 372.65, p < 0.001), and the coefficient of MMP2 were 26.81 (95% CI 7.95 to 45.68, p = 0.007). The scatter plots and regression lines of D/P creatinine, PAI1, and MMP2 in their association with ultrafiltration are shown in Fig. 1 . We further analyzed the association between ultrafiltration and effluent biomarkers using multivariable linear regression (Table 4 ). PAI1, independent of D/P creatinine and MMP2, was linked to ultrafiltration with a coefficient of 404.18 (95% CI 143.85 to 664.50, p = 0.003). Table 3 Coefficient of variables in association with ultrafiltration in univariable linear regression Factor Coefficient (95% CI) p Blood glucose (per mg/dl) 0.39 -2.33 to 3.10 0.774 Blood sodium (per meq/L) -11.69 -66.55 to 43.17 0.668 Blood creatinine (per mg/dl) -39.29 -90.49 to 11.91 0.128 Blood urea nitrogen (per mg/dl) -3.56 -8.94 to 1.81 0.187 D/P creatinine 1177.58 -74.11 to 2429.26 0.064 D/P sodium 5429.2 -2248.90 to 13107.31 0.16 D/P glucose -50.86 -118.98 to 17.25 0.138 Effluent Glucose (per mg/dl) -0.72 -1.54 to 0.10 0.082 Sodium (per meq/L) 14.53 -30.66 to 59.73 0.518 Creatinine (per mg/dl) -19.53 -89.22 to 50.16 0.573 MMP2 (per ng/ml) 26.81 7.95 to 45.68 0.007 PAI1 (per ng/ml) 252.28 131.88 to 372.68 < 0.001 AQP1 (per pg/ml) 0.01 -0.06 to 0.08 0.783 TLR4 (per pg/ml) -0.32 -1.31 to 0.66 0.509 CA125 (per IU/ml) 0.96 -3.77 to 5.68 0.683 MMP2: matrix metalloproteinase-2, PAI1: Plasminogen activator inhibitor-1, AQP1: Aquaporin1, TLR4: Toll-like receptor 4 Table 4 Coefficient of variables in association with ultrafiltration in multivariable linear regression explanatory Coefficient 95% (CI) p D/P creatinine -965.7 -2502.21 to 570.80 0.209 MMP2 -13.67 -47.19 to 19.84 0.411 PAI1 404.18 143.85 to 664.50 0.003 MMP2: matrix metalloproteinase-2, PAI1: Plasminogen activator inhibitor-1 Discussion PAI1 is an inhibitor of plasminogen activators and impairs the formation of plasmin. Plasmin is essential in the repair process of peritoneum injury [ 11 ], such as high glucose concentrations. PAI1 may protect the extracellular matrix from excessive degradation and interact with integrins, the urokinase receptor, and vitronectin [ 12 ]. PAI1 promotes cell migration through the interaction with integrins, urokinase receptors, and vitronectin. Cell migration is a vital process in peritoneal fibrosis [ 13 , 14 ]. PAI1 protects extracellular matrix degradation through the increase of MMP2. Upregulation of MMP2 may induce epithelial-to-mesenchymal transition in mesothelial cells [ 15 ]. The increased MMP2 and PAI1 in the effluent were also observed in the previous study [ 14 ]. Because the peritoneum of our patients was exposed to the high concentration of glucose (PD solution) for the first time, higher MMP2 and PAI1 may indicate a better response to glucose injury. A better response to glucose injury may suggest a better peritoneum function. A better peritoneum function is associated with higher ultrafiltration. The association between PAI1 and ultrafiltration may provide a useful clinical application and possible direction of treatment. We also explored the association of ultrafiltration between AQP1, CA125, and TLR4 in this study. AQP1 is a water channel facilitating water transport across cell membranes [ 16 ]. AQP1 is abundantly expressed in endothelial cells of peritoneal capillaries [ 17 ]. The common AQP1 promoter variant rs2075574 was associated with ultrafiltration. Carriers of the TT genotype at rs2075574 were associated with a higher risk of death and technique failure in PD patients [ 7 ]. CA125 (also known as mucin 16) is the largest transmembrane glycoprotein expressed by the peritoneal mesothelium. Effluent CA125 may reflect mesothelial cell mass in stable PD patients [ 18 ]. TLR4 is expressed in the peritoneal mesothelium and is related to a rapid inflammatory response to infections [ 8 ]. Activation of TLR4 leads to increased pro-inflammatory and fibrotic mediators of the peritoneum. However, none of AQP1, CA125, and TLR4 was significantly associated with ultrafiltration in this study. The study has some limitations. First, a fast PET was used in the study because the one-hour dwell is more applicable in clinical after PD catheter insertion. A good correlation between the first hour of fast PET and standard PET was supported in the previous study [ 10 ]. Second, The daily ultrafiltration of the first two days was analyzed, and the ultrafiltration of the first two days may not be consistent after two days. Third, we used a 2.5% dextrose PD solution in all patients. We did not know if a higher or lower concentration of dextrose may affect the readings of biomarkers. Conclusions The effluent PAI11 on PD catheter insertion predicts ultrafiltration in the first two days of PD. The prediction of PAI1 is independent of fast PET and MMP2. Declarations Ethics approval The study was approved by the institutional review board of China Medical University Hospital (CMUH108-REC1-080). Funding Asia University Hospital Research Grant (10951008, 10951021, 11151008, 11251005). The funders had no role in study design, data collection, analysis, decision to publish, or manuscript preparation. Conflicts of interest The authors declare that they have no competing interests. Availability of data and material The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Authors' contributions CY: draft article, JW: collecting the data and the patient recruitment, Charles C.N.: conceptualization, and formal anlaysis. All authors read and approved the final manuscript. Consent to participate Written informed consent was obtained from all participants Consent for publication Not applicable References Brown, E.A., et al., International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis. Perit Dial Int, 2020. 40 (3): p. 244-253. Boudville, N., et al., A different PET test: The relationship between pet ownership and peritonitis risk in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Perit Dial Int, 2023: p. 8968608221144450. Eibensteiner, F., et al., Monitoring Daily Ultrafiltration in Automated Peritoneal Dialysis. Clin J Am Soc Nephrol, 2022. 17 (1): p. 107-110. Gu, J., et al., Peritoneal equilibration testing: Your questions answered. Perit Dial Int, 2022: p. 8968608221133629. Rocco, M.V., J.R. Jordan, and J.M. Burkart, Changes in peritoneal transport during the first month of peritoneal dialysis. Perit Dial Int, 1995. 15 (1): p. 12-7. Lin, J.J., et al., Correlations between plasminogen activator inhibitor-1 and peritoneal transport in pediatric CCPD patients. Perit Dial Int, 1995. 15 (6): p. 246-51. Morelle, J., et al., AQP1 Promoter Variant, Water Transport, and Outcomes in Peritoneal Dialysis. N Engl J Med, 2021. 385 (17): p. 1570-1580. Raby, A.C., et al., Toll-Like Receptors 2 and 4 Are Potential Therapeutic Targets in Peritoneal Dialysis-Associated Fibrosis. J Am Soc Nephrol, 2017. 28 (2): p. 461-478. Barreto, D.L., et al., The Association of Effluent Ca125 with Peritoneal Dialysis Technique Failure. Perit Dial Int, 2015. 35 (7): p. 683-90. Akdam, H., et al., The fast peritoneal equilibration test first and second hour results. BANTAO Journal, 2015. 1 (22): p. 36-39. Rougier, J.P., et al., PAI-1 secretion and matrix deposition in human peritoneal mesothelial cell cultures: transcriptional regulation by TGF-beta 1. Kidney Int, 1998. 54 (1): p. 87-98. Wilkins-Port, C.E., et al., PAI-1: a multifunctional SERPIN with complex roles in cell signaling and migration. Cell Communication Insights, 2010. 3 : p. 1. Wadhwa, N.K., et al., Plasminogen activator inhibitor-1 and peritoneal transport in peritoneal dialysis patients. Adv Perit Dial, 1996. 12 : p. 33-8. Barreto, D.L., et al., Can effluent matrix metalloproteinase 2 and plasminogen activator inhibitor 1 be used as biomarkers of peritoneal membrane alterations in peritoneal dialysis patients? Perit Dial Int, 2013. 33 (5): p. 529-37. Tian, S., et al., SERPINH1 regulates EMT and gastric cancer metastasis via the Wnt/beta-catenin signaling pathway. Aging (Albany NY), 2020. 12 (4): p. 3574-3593. Agre, P., Aquaporin water channels (Nobel Lecture). Angew Chem Int Ed Engl, 2004. 43 (33): p. 4278-90. Devuyst, O., et al., Aquaporin-1 and endothelial nitric oxide synthase expression in capillary endothelia of human peritoneum. Am J Physiol, 1998. 275 (1): p. H234-42. Visser, C.E., et al., Cancer antigen 125: a bulk marker for the mesothelial mass in stable peritoneal dialysis patients. Nephrol Dial Transplant, 1995. 10 (1): p. 64-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4299168","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":296149333,"identity":"d20a0e90-b4df-433c-98a4-b69c3e390b25","order_by":0,"name":"Jia-Wen Lai","email":"","orcid":"","institution":"Asia University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jia-Wen","middleName":"","lastName":"Lai","suffix":""},{"id":296149334,"identity":"df24f08a-2cd4-471b-8389-1a3596c35f12","order_by":1,"name":"Charles C.N. 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Ultrafiltration and small solute clearance are usually accessed using the peritoneal equilibration test (PET). PET is widely used to guide PD prescriptions and prognosticate [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The first PET is typically performed 4\u0026ndash;8 weeks after initiation of PD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. PET is not used to predict ultrafiltration at the initiation of PD because PET results may change during the first month of PD [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. We aimed to explore if PET and biomarkers at the PD catheter insertion predict ultrafiltration in the first two days of PD. We reviewed the literature and selected five potential effluent biomarkers to predict ultrafiltration. The five biomarkers are matrix metalloproteinase-2 (MMP2), plasminogen activator inhibitor 1 (PAI1) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], aquaporin1 (AQP1) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], toll-like receptor 4 (TLR4) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and CA125 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. MMP-2 cleaves denatured collagen and complement other collagenases in the degradation of fibrillar collagens. Elevated effluent PAI-1 is presented in patients with intra-abdominal adhesions. MMP2 and PAI1 are involved in the process of peritoneal fibrosis and may be a potential biomarker for ultrafiltration. AQP1 is expressed is expressed in endothelial cells of peritoneal capillaries and may influence water transport. TLR4 is involved in the inflammation process of peritoneal mesothelial cells. CA125 reflects the mesothelial cell mass lining the peritoneal membrane.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study complied with the Declaration of Helsinki and was performed according to ethics committee approval. The study was approved by the institutional review board of China Medical University Hospital (CMUH108-REC2-080), and written informed consent was obtained from all participants. We enrolled patients based on the following inclusion criteria: at least 20 years, incident PD patients, and being able to give informed consent. The exclusion criteria were: younger than 20 years, having a history of PD, and unable to give informed consent. We enrolled 36 incident PD patients from July 2019 to June 2020. Two patients with technique failure after PD catheter insertion were excluded because no effluent was available. We performed a fast PET after PD catheter insertion; effluent samples were collected at 1 hour, and a blood sample was collected at 1 hour [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The 1-hour D/P ratios of creatinine were calculated in all patients. We measured effluent MMP2 (MMP2 Human ELISA Kit, Invitrogen, Catalog NO. KHC3081), PAI1(Human ELISA Kit, Invitrogen, Catalog NO. BMS2033), AQP1 (Human Aquaporin 1, AQP-1 ELISA Kit, CUSABIO, Catalog NO. CSB-E08248h), TLR4 (Human TLR-4 ELISA Kit, Invitrogen, Catalog NO. EH460RB), and CA125 (CA125 Human ELISA Kit, Invitrogen, Catalog NO. EHMUC16) following the manufacturer's instructions. Patient characteristics, including age, gender, hypertension, diabetes, primary kidney disease, height, weight, systolic blood pressure, and diastolic blood pressure, were collected at the enrollments. Body surface area was calculated as 0.007184 \u0026times; height (cm)\u003csup\u003e0.725\u003c/sup\u003e \u0026times; weight (kg)\u003csup\u003e0.425\u003c/sup\u003e. All patients had four exchanges of one liter of 2.5% dextrose dialysate with a 4-hour dwell for two days after PD catheter insertion. We recorded the daily ultrafiltration, and the average values were calculated.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData are reported as the means (standard deviations) or frequencies (percentages) where appropriate. The association of ultrafiltration and variables was analyzed using linear regression. The variables' coefficient and 95% confidence interval (CI) were calculated. The sample size (N\u0026thinsp;=\u0026thinsp;20) was calculated using Fisher's Z test based on the coefficient of PAI1 and ultrafiltration [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] with a power of 0.8 and a p-value of 0.05. All analyses were performed using R Statistical Software (version 4.2.1, R Foundation for Statistical Computing, Vienna, Austria) with finalfit packages. A p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the 36 enrolled patients was 69\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years, and 61.1% were male (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Sixteen (44.4%) patients had diabetes, and 27 (75%) patients had hypertension. Diabetes was the primary kidney disease in 13 (36.1%) patients, hypertension in 13 (36.1%) patients, and chronic glomerulonephritis in 6 (16.7%) patients. The average height was 160\u0026thinsp;\u0026plusmn;\u0026thinsp;10 cm, weight 65\u0026thinsp;\u0026plusmn;\u0026thinsp;15 kg, and body surface area 1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 m\u003csup\u003e2\u003c/sup\u003e. The systolic blood pressure was 136\u0026thinsp;\u0026plusmn;\u0026thinsp;30 mmHg, and the diastolic blood pressure was 68\u0026thinsp;\u0026plusmn;\u0026thinsp;19 mmHg. The blood urea nitrogen was 104\u0026thinsp;\u0026plusmn;\u0026thinsp;50 mg/dl, creatinine 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 mg/dl, sodium 134\u0026thinsp;\u0026plusmn;\u0026thinsp;5 meq/L, and blood glucose 202\u0026thinsp;\u0026plusmn;\u0026thinsp;99 mg/dl. The D/D0 glucose was 0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2. The effluent MMP2 was 13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 ng/ml, AQP1 4624.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3946.1 pg/ml, PAI1 1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 ng/ml, TLR4 1334.3\u0026thinsp;\u0026plusmn;\u0026thinsp;277.9 pg/ml, and CA125 85.6\u0026thinsp;\u0026plusmn;\u0026thinsp;58.2 IU/ml.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of all patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;36\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrimary kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic glomerulonephritis (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther (n%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody surface area (m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic blood pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood urea nitrogen (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (meq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average daily ultrafiltration was 652\u0026thinsp;\u0026plusmn;\u0026thinsp;775ml (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The D/P creatinine was 0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21, D/P sodium 0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03, D/P glucose 5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84. The MMP2 in the effluent was 13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1ng/ml, AQP1 4627.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3946.1 pg/ml, PAI1 1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 ng/ml, TLR4 1334.3\u0026thinsp;\u0026plusmn;\u0026thinsp;277.9, and CA125 85.6\u0026thinsp;\u0026plusmn;\u0026thinsp;58.2 IU/ml.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDaily average ultrafiltration and effluent biomarkers of all patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrafiltration (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P creatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P sodium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P glucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffluent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (meq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMatrix metalloproteinase-2 (MMP2, ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAquaporin 1 (AQP1, pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4627.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3946.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlasminogen activator inhibitor-1 (PAI1, ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToll-like receptor 4 (TLR4, pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1334.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;277.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA125 (IU/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;58.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe coefficient of D/D0 glucose was 1177.58 (95% CI:-74.11 to 2429.26, p\u0026thinsp;=\u0026thinsp;0.064) in univariable linear regression (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The D/P sodium and D/P glucose were not associated with ultrafiltration. The blood glucose, sodium, creatine, and urea nitrogen were not significantly associated with ultrafiltration. The coefficient of effluent glucose was \u0026minus;\u0026thinsp;0.72 (95% CI -1.54 to 0.10, p\u0026thinsp;=\u0026thinsp;0.082). The effluent creatine, sodium, and urea nitrogen were not linked to ultrafiltration. PAI1 and MMP2 were significantly associated with ultrafiltration. The coefficient of PAI1 was 252.28 (95% CI 131.88 to 372.65, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the coefficient of MMP2 were 26.81 (95% CI 7.95 to 45.68, p\u0026thinsp;=\u0026thinsp;0.007). The scatter plots and regression lines of D/P creatinine, PAI1, and MMP2 in their association with ultrafiltration are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. We further analyzed the association between ultrafiltration and effluent biomarkers using multivariable linear regression (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). PAI1, independent of D/P creatinine and MMP2, was linked to ultrafiltration with a coefficient of 404.18 (95% CI 143.85 to 664.50, p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoefficient of variables in association with ultrafiltration in univariable linear regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCoefficient (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood glucose (per mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.33 to 3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood sodium (per meq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-11.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-66.55 to 43.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood creatinine (per mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-39.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-90.49 to 11.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood urea nitrogen (per mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-8.94 to 1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P creatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1177.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-74.11 to 2429.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P sodium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5429.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2248.90 to 13107.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P glucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-50.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-118.98 to 17.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffluent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (per mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.54 to 0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (per meq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-30.66 to 59.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (per mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-19.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-89.22 to 50.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMP2 (per ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.95 to 45.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAI1 (per ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e252.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131.88 to 372.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAQP1 (per pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.06 to 0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLR4 (per pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.31 to 0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCA125 (per IU/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.77 to 5.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eMMP2: matrix metalloproteinase-2, PAI1: Plasminogen activator inhibitor-1, AQP1: Aquaporin1, TLR4: Toll-like receptor 4\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoefficient of variables in association with ultrafiltration in multivariable linear regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eexplanatory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% (CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD/P creatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-965.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2502.21 to 570.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-13.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-47.19 to 19.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAI1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e404.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143.85 to 664.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eMMP2: matrix metalloproteinase-2, PAI1: Plasminogen activator inhibitor-1\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePAI1 is an inhibitor of plasminogen activators and impairs the formation of plasmin. Plasmin is essential in the repair process of peritoneum injury [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], such as high glucose concentrations. PAI1 may protect the extracellular matrix from excessive degradation and interact with integrins, the urokinase receptor, and vitronectin [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. PAI1 promotes cell migration through the interaction with integrins, urokinase receptors, and vitronectin. Cell migration is a vital process in peritoneal fibrosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. PAI1 protects extracellular matrix degradation through the increase of MMP2. Upregulation of MMP2 may induce epithelial-to-mesenchymal transition in mesothelial cells [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The increased MMP2 and PAI1 in the effluent were also observed in the previous study [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Because the peritoneum of our patients was exposed to the high concentration of glucose (PD solution) for the first time, higher MMP2 and PAI1 may indicate a better response to glucose injury. A better response to glucose injury may suggest a better peritoneum function. A better peritoneum function is associated with higher ultrafiltration. The association between PAI1 and ultrafiltration may provide a useful clinical application and possible direction of treatment.\u003c/p\u003e \u003cp\u003eWe also explored the association of ultrafiltration between AQP1, CA125, and TLR4 in this study. AQP1 is a water channel facilitating water transport across cell membranes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. AQP1 is abundantly expressed in endothelial cells of peritoneal capillaries [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The common AQP1 promoter variant rs2075574 was associated with ultrafiltration. Carriers of the TT genotype at rs2075574 were associated with a higher risk of death and technique failure in PD patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. CA125 (also known as mucin 16) is the largest transmembrane glycoprotein expressed by the peritoneal mesothelium. Effluent CA125 may reflect mesothelial cell mass in stable PD patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. TLR4 is expressed in the peritoneal mesothelium and is related to a rapid inflammatory response to infections [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Activation of TLR4 leads to increased pro-inflammatory and fibrotic mediators of the peritoneum. However, none of AQP1, CA125, and TLR4 was significantly associated with ultrafiltration in this study.\u003c/p\u003e \u003cp\u003eThe study has some limitations. First, a fast PET was used in the study because the one-hour dwell is more applicable in clinical after PD catheter insertion. A good correlation between the first hour of fast PET and standard PET was supported in the previous study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Second, The daily ultrafiltration of the first two days was analyzed, and the ultrafiltration of the first two days may not be consistent after two days. Third, we used a 2.5% dextrose PD solution in all patients. We did not know if a higher or lower concentration of dextrose may affect the readings of biomarkers.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe effluent PAI11 on PD catheter insertion predicts ultrafiltration in the first two days of PD. The prediction of PAI1 is independent of fast PET and MMP2.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review board of China Medical University Hospital (CMUH108-REC1-080).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAsia University Hospital Research Grant (10951008, 10951021, 11151008, 11251005). The funders had no role in study design, data collection, analysis, decision to publish, or manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCY: draft article, JW: collecting the data and the patient recruitment, Charles C.N.: conceptualization, and formal anlaysis.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrown, E.A., et al., \u003cem\u003eInternational Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis.\u003c/em\u003e Perit Dial Int, 2020. \u003cstrong\u003e40\u003c/strong\u003e(3): p. 244-253.\u003c/li\u003e\n\u003cli\u003eBoudville, N., et al., \u003cem\u003eA different PET test: The relationship between pet ownership and peritonitis risk in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).\u003c/em\u003e Perit Dial Int, 2023: p. 8968608221144450.\u003c/li\u003e\n\u003cli\u003eEibensteiner, F., et al., \u003cem\u003eMonitoring Daily Ultrafiltration in Automated Peritoneal Dialysis.\u003c/em\u003e Clin J Am Soc Nephrol, 2022. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 107-110.\u003c/li\u003e\n\u003cli\u003eGu, J., et al., \u003cem\u003ePeritoneal equilibration testing: Your questions answered.\u003c/em\u003e Perit Dial Int, 2022: p. 8968608221133629.\u003c/li\u003e\n\u003cli\u003eRocco, M.V., J.R. Jordan, and J.M. Burkart, \u003cem\u003eChanges in peritoneal transport during the first month of peritoneal dialysis.\u003c/em\u003e Perit Dial Int, 1995. \u003cstrong\u003e15\u003c/strong\u003e(1): p. 12-7.\u003c/li\u003e\n\u003cli\u003eLin, J.J., et al., \u003cem\u003eCorrelations between plasminogen activator inhibitor-1 and peritoneal transport in pediatric CCPD patients.\u003c/em\u003e Perit Dial Int, 1995. \u003cstrong\u003e15\u003c/strong\u003e(6): p. 246-51.\u003c/li\u003e\n\u003cli\u003eMorelle, J., et al., \u003cem\u003eAQP1 Promoter Variant, Water Transport, and Outcomes in Peritoneal Dialysis.\u003c/em\u003e N Engl J Med, 2021. \u003cstrong\u003e385\u003c/strong\u003e(17): p. 1570-1580.\u003c/li\u003e\n\u003cli\u003eRaby, A.C., et al., \u003cem\u003eToll-Like Receptors 2 and 4 Are Potential Therapeutic Targets in Peritoneal Dialysis-Associated Fibrosis.\u003c/em\u003e J Am Soc Nephrol, 2017. \u003cstrong\u003e28\u003c/strong\u003e(2): p. 461-478.\u003c/li\u003e\n\u003cli\u003eBarreto, D.L., et al., \u003cem\u003eThe Association of Effluent Ca125 with Peritoneal Dialysis Technique Failure.\u003c/em\u003e Perit Dial Int, 2015. \u003cstrong\u003e35\u003c/strong\u003e(7): p. 683-90.\u003c/li\u003e\n\u003cli\u003eAkdam, H., et al., \u003cem\u003eThe fast peritoneal equilibration test first and second hour results.\u003c/em\u003e BANTAO Journal, 2015. \u003cstrong\u003e1\u003c/strong\u003e(22): p. 36-39.\u003c/li\u003e\n\u003cli\u003eRougier, J.P., et al., \u003cem\u003ePAI-1 secretion and matrix deposition in human peritoneal mesothelial cell cultures: transcriptional regulation by TGF-beta 1.\u003c/em\u003e Kidney Int, 1998. \u003cstrong\u003e54\u003c/strong\u003e(1): p. 87-98.\u003c/li\u003e\n\u003cli\u003eWilkins-Port, C.E., et al., \u003cem\u003ePAI-1: a multifunctional SERPIN with complex roles in cell signaling and migration.\u003c/em\u003e Cell Communication Insights, 2010. \u003cstrong\u003e3\u003c/strong\u003e: p. 1.\u003c/li\u003e\n\u003cli\u003eWadhwa, N.K., et al., \u003cem\u003ePlasminogen activator inhibitor-1 and peritoneal transport in peritoneal dialysis patients.\u003c/em\u003e Adv Perit Dial, 1996. \u003cstrong\u003e12\u003c/strong\u003e: p. 33-8.\u003c/li\u003e\n\u003cli\u003eBarreto, D.L., et al., \u003cem\u003eCan effluent matrix metalloproteinase 2 and plasminogen activator inhibitor 1 be used as biomarkers of peritoneal membrane alterations in peritoneal dialysis patients?\u003c/em\u003e Perit Dial Int, 2013. \u003cstrong\u003e33\u003c/strong\u003e(5): p. 529-37.\u003c/li\u003e\n\u003cli\u003eTian, S., et al., \u003cem\u003eSERPINH1 regulates EMT and gastric cancer metastasis via the Wnt/beta-catenin signaling pathway.\u003c/em\u003e Aging (Albany NY), 2020. \u003cstrong\u003e12\u003c/strong\u003e(4): p. 3574-3593.\u003c/li\u003e\n\u003cli\u003eAgre, P., \u003cem\u003eAquaporin water channels (Nobel Lecture).\u003c/em\u003e Angew Chem Int Ed Engl, 2004. \u003cstrong\u003e43\u003c/strong\u003e(33): p. 4278-90.\u003c/li\u003e\n\u003cli\u003eDevuyst, O., et al., \u003cem\u003eAquaporin-1 and endothelial nitric oxide synthase expression in capillary endothelia of human peritoneum.\u003c/em\u003e Am J Physiol, 1998. \u003cstrong\u003e275\u003c/strong\u003e(1): p. H234-42.\u003c/li\u003e\n\u003cli\u003eVisser, C.E., et al., \u003cem\u003eCancer antigen 125: a bulk marker for the mesothelial mass in stable peritoneal dialysis patients.\u003c/em\u003e Nephrol Dial Transplant, 1995. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 64-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"peritoneal dialysis, ultrafiltration, PAI1, plasminogen activator inhibitor-1, peritoneal equilibration test, PET, MMP2","lastPublishedDoi":"10.21203/rs.3.rs-4299168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4299168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe peritoneal equilibration test (PET) measures ultrafiltration and small solute clearance in peritoneal dialysis (PD). We aimed to assess if PET and biomarkers predict ultrafiltration in the first two days of PD. Biomarkers included in the study were matrix metalloproteinase-2 (MMP2), plasminogen activator inhibitor 1 (PAI1), aquaporin1 (AQP1), toll-like receptor 4 (TLR4), and CA125.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe enrolled 36 incident PD patients, and a fast PET was performed after the PD catheter insertion. Effluent MMP2, PAI1, AQP1, TLR4, and CA125 were collected with the fast PET and were measured using commercially available ELISA kits. The association of ultrafiltration and variables was analyzed using linear regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of 36 patients was 69\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years, and 22 (61.1%) patients were male. The average daily ultrafiltration was 652\u0026thinsp;\u0026plusmn;\u0026thinsp;775 ml in the first two days of PD. The D/P creatinine 1-hour was 0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21, MMP2 13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 ng/ml, and PAI1 1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 ng/ml. MMP2 (p\u0026thinsp;=\u0026thinsp;0.007) and PAI1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with ultrafiltration in univariable linear regression, but D/P creatinine (p\u0026thinsp;=\u0026thinsp;0.064) was not. PAI1, independent of MMP2 and D/P creatinine, was associated with ultrafiltration with a coefficient of 404.18 (95% confident intervals 143.85 to 664.50, p\u0026thinsp;=\u0026thinsp;0.003) in multivariable linear regression.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMeasurements of effluent PAI1 at the PD catheter insertion predict ultrafiltration in the first two days of PD. The association of PAI1 and ultrafiltration is independent of MMP2 and D/P creatinine using fast PET.\u003c/p\u003e","manuscriptTitle":"Effluent plasminogen activator inhibitor 1 predicts ultrafiltration in incident peritoneal dialysis patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-30 19:53:25","doi":"10.21203/rs.3.rs-4299168/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9dbb33b9-db53-4ea8-a119-12f658d8c194","owner":[],"postedDate":"April 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-05T14:51:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-30 19:53:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4299168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4299168","identity":"rs-4299168","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}