Diabetes Influences Peritoneal Morphology in Uremic Patients at the Initiation of Peritoneal Dialysis

Abstract

BackgroundThe peritoneum begins to undergo morphologic changes before the start of peritoneal dialysis (PD), particularly in diabetic patients. The present study was conducted to investigate the effects of diabetes on the peritoneum.MethodsThis study involved 17 patients who began receiving PD and had diabetes as an underlying disease (DM group), and 30 patients without diabetes who served as a control group (nonDM group). At the start of PD, the parietal peritoneum was sampled to assess submesothelial connective tissue thickness, number of capillaries and postcapillary venules, and indications of vasculopathy (grades 0 – 3).ResultsSubmesothelial connective tissue thickness was significantly greater in the DM group than in the nonDM group ( p < 0.01). The number of capillaries was significantly greater in the DM group ( p < 0.01). Based on multivariate linear regression analysis, diabetes was identified as a significant independent variable of both submesothelial connective tissue thickness and number of capillaries ( p < 0.01).ConclusionsIn diabetic patients, morphologic changes of the peritoneum are marked at the start of PD.

Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

“…In their classic study, Williams et al [29] did not detect differences in the interstitial and vascular changes observed in peritoneal biopsies from diabetic and nondiabetic patients on PD. On the contrary, a more recent study [30] detected an increased thickness of the submesothelial space and a higher capillary density in peritoneal biopsies from diabetics starting PD. These changes could exert an additive effect to impair transperitoneal water transport, with less predictable effects on small solute transport, which essentially agrees with our results.…”

Proposal of peritoneal biopsy procedures for patients undergoing peritoneal dialysis

“…To the best of our knowledge, only a few studies have reported on the methodology of peritoneal biopsy [7][8][9][10]. Moreover, a detailed biopsy procedure has been described in only one study [7], where the authors have proposed a suture method for collecting peritoneal samples.…”

“…The purpose of a peritoneal biopsy is to evaluate the degree of peritoneal damage caused by PD and to evaluate the risk for EPS progression. The evaluation items include denudation of and morphological changes in mesothelial cells [1,8], thickness and degeneration of submesothelial connective tissue [1-3, 8, 12-18], degree of vasculopathy [1-3, 8, 12-20], angiogenesis [1,8,12,[14][15][16][17][20][21][22], and presence of new membrane formation on the existing peritoneum [15,17]. The thickness of the submesothelial connective tissue is usually measured based on the thickness of the so-called submesothelial compact zone (SCZ) immediately below the mesothelial cell layer to the fatty tissue layer.…”

“…The thickness of the submesothelial connective tissue is usually measured based on the thickness of the so-called submesothelial compact zone (SCZ) immediately below the mesothelial cell layer to the fatty tissue layer. The evaluated value includes the following: the mean of SCZ thickness at several randomly selected sites [2,3,8,[12][13][14][15], maximum SCZ thickness [1], mean of the maximum and minimum SCZ thickening degrees [16,17], or mean of whole SCZ thickness [18]. Post-capillary venule (PCV), which normal size is from 25 to 50 μm, is usually used to evaluate vasculopathy.…”

“…At our hospital, peritoneal biopsy examinations are performed not only after the cessation of PD but also before the initiation of PD to evaluate the serial morphological changes induced by PD in the peritoneum. A unified method for performing peritoneal biopsy remains to be established because, to date, few studies have reported on its methodology [7][8][9]. Therefore, the technique for a peritoneal biopsy varies across institutions.…”