Impact of Uremia, Diabetes, and Peritoneal Dialysis Itself on the Pathogenesis of Peritoneal Sclerosis

Honda, Kazuho; Hamada, Chikuma; Nakayama, Masaaki; Miyazaki, Masanobu; Sherif, Ali M.; Harada, Takashi; Honda, Hiroshi

doi:10.2215/cjn.03630807

Cited by 144 publications

(183 citation statements)

References 15 publications

(11 reference statements)

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“…Morphologic changes in the peritoneum have been shown to be present before the start of PD, regardless of the presence or absence of diabetes (4,5). The present study did not evaluate peritoneal samples from healthy individuals; however, compared with the approximately 50 -60 μm submesothelial connective tissue reported for healthy individuals by the previously mentioned studies, the submesothelial connective tissue from the patients in the present study showed thickening.…”

Section: Discussioncontrasting

confidence: 49%

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

et al. 2013

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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.

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Section: Discussioncontrasting

confidence: 49%

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

et al. 2013

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“…[3][4][5] Prolonged exposure of the peritoneal membrane to nonphysiologic dialysis solutions leads to vascular proliferation, vasculopathy, and peritoneal fibrosis, with ensuing loss of ultrafiltration (UF) capacity resulting from enlarged vascular surface area, faster peritoneal solute transport rate, and early dissipation of the osmotic gradient. 3,4,[6][7][8][9] Encapsulating peritoneal sclerosis (EPS) is an exaggerated fibrogenic response of the peritoneal membrane, leading to encapsulation of the bowels and intestinal obstruction. This entity constitutes the most severe complication of PD (for review, see Korte et al 10 ).…”

mentioning

confidence: 99%

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

Morelle

Sow

Hautem

et al. 2015

Journal of the American Society of Nephrology

102

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Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis (PD) characterized by extensive fibrosis of the peritoneum. Changes in peritoneal water transport may precede EPS, but the mechanisms and potential predictive value of that transport defect are unknown. Among 234 patients with ESRD who initiated PD at our institution over a 20-year period, 7 subsequently developed EPS. We evaluated changes in peritoneal transport over time on PD in these 7 patients and in 28 matched controls using 3.86% glucose peritoneal equilibration tests. Compared with long-term PD controls, patients with EPS showed early loss of ultrafiltration capacity and sodium sieving before the onset of overt EPS. Multivariate analysis revealed that loss of sodium sieving was the most powerful predictor of EPS. Compared with long-term PD control and uremic peritoneum, EPS peritoneum showed thicker submesothelial fibrosis, with increased collagen density and a greater amount of thick collagen fibers. Reduced osmotic conductance strongly correlated with the degree of peritoneal fibrosis, but not with vasculopathy. Peritoneal fibrosis was paralleled by an excessive upregulation of vascular endothelial growth factor and endothelial nitric oxide synthase, but the expression of endothelial aquaporin-1 water channels was unaltered. Our findings suggest that an early and disproportionate reduction in osmotic conductance during the course of PD is an independent predictor of EPS. This functional change is linked to specific alterations of the collagen matrix in the peritoneal membrane of patients with EPS, thereby validating the serial three-pore membrane/fiber matrix and distributed models of peritoneal transport.

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“…Peritoneal biopsy specimens were cut from the parietal peritoneum using a scalpel or peeled from the encapsulated visceral peritoneum and processed by routine histological procedures as previously described [16]. The adequacy of specimens for histological evaluation was determined in terms of size, site, and direction of the samples as described in the previous report [16].…”

Section: Histopathological Analysismentioning

confidence: 99%

Significance of new membrane formation in peritoneal biopsies of peritoneal dialysis patients: a case–control study

et al. 2017

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and on behalf of the Peritoneal Pathology Study Committee of Japanese Society of Peritoneal Dialysis (JSPD) 7 AbstractBackground: Newly formed membrane (NFM) on the peritoneal membrane proper is a unique pathological hallmark of encapsulating peritoneal sclerosis (EPS), but its definition and diagnostic significance have not been well described. This study investigated the pathological features of NFM in EPS and prevalence of NFM in peritoneal biopsy at catheter removal.

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Impact of Uremia, Diabetes, and Peritoneal Dialysis Itself on the Pathogenesis of Peritoneal Sclerosis

Cited by 144 publications

References 15 publications

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

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

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

Significance of new membrane formation in peritoneal biopsies of peritoneal dialysis patients: a case–control study

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