Histomorphological and functional changes of the peritoneal membrane during long-term peritoneal dialysis

Abstract

In long-term peritoneal dialysis (PD) morphological and functional changes of the peritoneal membrane are common. Sub-mesothelial fibrosis, angiogenesis and vasculopathy are typical histomorphological alterations of the peritoneal membrane, which, to a certain degree, are induced by uremia and recurrent peritonitis. The most important causative factor, however, represents the chronic exposure to PD solutions. Glucose, glucose degradation products and advanced glycation end-products (AGEs) via different pathways induce inflammation, fibrosis and angiogenesis. As a functional consequence ultrafiltration failure due to peritoneal hyperpermeability and an increased effective peritoneal surface area represents a major clinical problem. An insufficient function of the water-selective aquaporin 1 (AQP-1) channel may also be causative for inadequate ultrafiltration. A rare but life-threatening complication of long-term PD is encapsulating peritoneal sclerosis (EPS). For both impaired AQP-1 function and EPS, the long-term effects of PD fluids are believed to be responsible, even though the mechanisms are not yet understood. The avoidance of glucose and modern PD fluids with fewer glucose degradation products, as well as first pharmacological attempts may help to preserve the peritoneal membrane in the long term.

Modulation of Inflammation by Mesenchymal Stem Cell Transplantation in Peritoneal Dialysis in Rats

“…[1][2][3]5,10 As similar to our study, in a rat model for PD, it was seen that there was an increase in submesothelial thickness and number of inflammatory cells and vessels in the peritoneum after receiving PD fluid with 3.86% glucose by a dialysis catheter for 5 weeks. 11 Williams et al 10 evaluated peritoneum of the * # § x + Figure 4.…”

“…Our findings indicated that chronic PD increase inflammation. 2,3,12,13 In the stem cell treatment, several labeling methods were used to determine whether tissue regeneration is driven by the effect of exogenous stem cells. [14][15][16] In our study, GFP labeling was employed and it was seen that GFP-labeled MSC was present in the mesothelium line at immunofluorescent microscopic evaluation.…”

“…All these lead to ultrafiltration failure. [1][2][3][4] At 2-6 years, ultrafiltration failure occurs in about 30% of PD patients. 5 Mesenchymal stem cells (MSCs) are self-renewing with a capacity to differentiate into several different cell types from all three germ layers.…”

Evaluation for Peritoneal Injury at an Early Stage Using Dual Macromolecular Markers

“…However, long-term PD frequently produces morphological and functional changes of the peritoneum, making continuation of PD difficult. [4][5][6][7][8] Moreover, progression of peritoneal injury causes serious complications, such as encapsulating peritoneal sclerosis. 9) Therefore, it is necessary to evaluate peritoneal injury at an early stage and develop appropriate treatments for peritoneal injury.…”

Novel Diagnostic Method of Peritoneal Injury Using Dual Macromolecular Markers

“…4) A reason for this is that long-term PD frequently produces morphological and functional changes of the peritoneum, which leads to discontinuation of PD. [5][6][7][8][9] Moreover, progression of peritoneal injury causes serious complications, such as encapsulating peritoneal sclerosis (EPS). 10) Since therapeutic treatments for peritoneal injury and EPS have yet to be established, 11,12) patients are forced to switch from PD to HD when peritoneal injury occurs.…”