The relationship between baseline high peritoneal solute transport rate (PSTR) and the prognosis of peritoneal dialysis (PD) patients remains unclear. The present study combined clinical data and basic experiments to investigate the impact of baseline PSTR and the underlying molecular mechanisms. A total of 204 incident CAPD patients from four PD centres in Shanghai between 1 January 2014 and 30 September 2020 were grouped based on a peritoneal equilibration test after the first month of dialysis. Analysed with multivariate Cox and logistic regression models, baseline high PSTR was a significant risk factor for technique failure (AHR 5.70; 95% CI 1.581 to 20.548 p = 0.008). Baseline hyperuricemia was an independent predictor of mortality (AHR 1.006 95%CI 1.003 to 1.008, p < 0.001) and baseline high PSTR (AOR 1.007; 95%CI 1.003 to 1.012; p = 0.020). Since uric acid was closely related to high PSTR and adverse prognosis, the in vitro experiments were performed to explore the underlying mechanisms of which uric acid affected peritoneum. We found hyperuricemia induced epithelial-to-mesenchymal transition (EMT) of cultured human peritoneal mesothelial cells by activating TGF-β1/Smad3 signalling pathway and nuclear transcription factors. Conclusively, high baseline PSTR induced by hyperuricaemia through EMT was an important reason of poor outcomes in CAPD patients.

中文翻译：

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腹膜透析患者基线高腹膜转运蛋白的预后及危险因素

基线高腹膜溶质转运率（PSTR）与腹膜透析（PD）患者预后之间的关系仍不清楚。本研究结合临床数据和基础实验来研究基线 PSTR 的影响和潜在的分子机制。2014 年 1 月 1 日至 2020 年 9 月 30 日期间，来自上海四个 PD 中心的 204 例 CAPD 患者在透析第一个月后根据腹膜平衡测试进行分组。使用多变量 Cox 和逻辑回归模型分析，基线高 PSTR 是技术失败的重要风险因素（AHR 5.70；95% CI 1.581 至 20.548 p  = 0.008）。基线高尿酸血症是死亡率的独立预测因子（AHR 1.006 95%CI 1.003 至 1.008，p < 0.001）和基线高 PSTR（AOR 1.007；95%CI 1.003 至 1.012；p  = 0.020）。由于尿酸与高PSTR和不良预后密切相关，因此进行了体外实验以探索尿酸影响腹膜的潜在机制。我们发现高尿酸血症通过激活 TGF-β1/Smad3 信号通路和核转录因子诱导培养的人腹膜间皮细胞的上皮间质转化 (EMT)。总之，高尿酸血症通过 EMT 诱导的高基线 PSTR 是 CAPD 患者预后不良的重要原因。