Protective measures against ultrafiltration failure in peritoneal dialysis patients

Aguirre, Anna Rita; Abensur, Hugo

doi:10.1590/s1807-59322011001200023

Cited by 11 publications

(9 citation statements)

References 101 publications

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“…The hyperglycemia-induced microvascular changes in the peritoneal membrane were mostly prevented by application of monoclonal anti-VEGF antibodies, while treatment with non-specific control antibodies was not effective. These experimental findings confirmed that VEGF plays an important role in glucose-induced neoangiogenesis and hyperpermeability of the peritoneal membrane in long-term PD [2,3,6].…”

Section: Discussionsupporting

confidence: 71%

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The relationship between vascular endothelial growth factor (VEGF) in the serum and drained dialysate with the quality of peritoneal dialysis and peritoneal membrane transport rates

Jovanović

Žunić²,

Trbojević-Stanković

et al. 2019

ARCH BIOL SCI BELGRA

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Vascular endothelial growth factor (VEGF), a powerful angiogenetic agent crucial for microvascular hyperpermeability and neoangiogenesis in the peritoneum, is associated with increased solute transport rates in chronic peritoneal dialysis (PD) patients. We investigated the correlation between serum and drained dialysate (dd) concentrations of VEGF and the transport characteristics of peritoneal membrane and dialysis quality in 20 patients with end-stage renal failure at the beginning and after six months of PD. The serum VEGF (sVEGF) concentration rose significantly (149.33?}116.71 pg/ mL vs 239.36?}102.23 pg/mL; p=0.012) and ddVEGF concentration increased slightly (38.44?}50.47 pg/mL vs 43.55?}51.10 pg/mL) during the first 6 months of PD. At the beginning of chronic PD, ddVEGF concentrations correlated inversely with the peritoneal equilibrium test (PET) glucose (R=-0.565; p=0.009) and creatinine (R=-0.506; p=0.023) and residual renal function (RRF) (R=-0.691; p=0.001); sVEGF concentrations inversely correlated with PET creatinine (R=-0.457; p=0.043) and residual diuresis (RD) (R=-0.691; p=0.001). After 6 months of treatment, ddVEGF concentrations correlated directly with PETcreatinine (R=0.450; p=0.047), and inversely with RRF (R=-0.552; p=0.012) and residual renal weekly Kt/V (R=-0.488; p=0.029). The sVEGF concentration inversely correlated with RD (R=-0.589; p=0.006). High ddVEGF at the beginning of PD is predictive of adverse alterations of the peritoneal membrane, i.e. increased transport rate of glucose and creatinine. ddVEGF values may help to identify patients who will preserve adequate transport characteristics of the peritoneal membrane and maintain successful long-term PD. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 145070]

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Section: Discussionsupporting

confidence: 71%

“…Angiogenesis is the formation of new blood vessels from pre-existing endothelium. Some angiogenetic factors, such as VEGF, are increased in uremic conditions and upon exposure to high glucose solution during PD [6].…”

Section: Introductionmentioning

confidence: 99%

The relationship between vascular endothelial growth factor (VEGF) in the serum and drained dialysate with the quality of peritoneal dialysis and peritoneal membrane transport rates

Jovanović

Žunić²,

Trbojević-Stanković

et al. 2019

ARCH BIOL SCI BELGRA

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“…The long-term PD-associated progressive peritoneal membrane injury resulting in sterile peritoneal inflammation and fibrosis has been well documented. 5,6 The prolonged exposure to conventional PDS has been demonstrated to substantially contribute to peritoneal membrane injury and chronic low-grade inflammation 26 and a number of biomarkers have been evaluated in an attempt to help improve PD patient outcomes. 27 Acidic pH, high glucose concentrations and high levels of glucose degradation products in PDS have all been reported to cause local inflammation with resultant adverse functional outcomes, such as higher peritoneal solute transport rate (PSTR) and membrane failure due to fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Targeting Toll-like receptors with soluble Toll-like receptor 2 prevents peritoneal dialysis solution–induced fibrosis

Raby

González-Mateo

Williams

et al. 2018

Kidney International

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Peritoneal membrane failure due to fibrosis limits the use of peritoneal dialysis (PD). Peritoneal fibrosis may potentially be induced by sterile inflammation caused by ongoing cellular stress due to prolonged exposure to PD solutions (PDS). Effective therapies to prevent this process remain to be developed. Toll-like receptors (TLRs) mediate sterile inflammation by recognizing damage-associated molecular patterns (DAMPs) released by cellular stress. We evaluated the involvement of TLRs and DAMPs in PDS-induced fibrosis models and the therapeutic potential of TLR-DAMP targeting for preventing fibrosis. A range of PDS elicited pro-inflammatory and fibrotic responses from PD patient peritoneal leukocytes, mesothelial cells and mouse peritoneal leukocytes. TLR2/4 blockade of human peritoneal cells or TLR2/4 knockouts inhibited these effects. PDS did not induce rapid ERK phosphorylation or IκB-α degradation, suggesting that they do not contain components capable of direct TLR activation. However, PDS increased the release of Hsp70 and hyaluronan, both TLR2/4 DAMP ligands, by human and mouse peritoneal cells, and their blockade decreased PDS-driven inflammation. Soluble TLR2, a TLR inhibitor, reduced PDS-induced pro-inflammatory and fibrotic cytokine release ex vivo. Daily catheter infusion of PDS in mice caused peritoneal fibrosis, but co-administration of soluble TLR2 prevented fibrosis, suppressed pro-fibrotic gene expression and pro-inflammatory cytokine production, reduced leukocyte/neutrophil recruitment, recovered Treg cell levels and increased the Treg:Th17 ratio. Thus, TLR2/4, Hsp70 and hyaluronan showed major roles in PDS-induced peritoneal inflammation and fibrosis. The study demonstrates the therapeutic potential of a TLR-DAMP targeting strategy to prevent PDS-induced fibrosis.

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“…The prevalence of UF increases with duration of PD, so that 30-50% of patients with PD develop UF, many patients abandon PD due to UF, and dropout increases depending on the type of PD. It has been reported up to 3% of dropouts during the first year and 31% after the next six years [59,84].…”

Section: Ultrafiltration Failurementioning

confidence: 99%

Fluid Overload in Peritoneal Dialysis

Pazarín-Villaseñor¹,

Yanowsky-Escatell²,

Andrade‐Sierra³

et al. 2018

Chronic Kidney Disease - From Pathophysiology to Clinical Improvements

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The prevalence of end-stage renal disease (ESRD) has increased globally to 10% due to diabetes mellitus, hypertension, and stroke. When chronic kidney disease (CKD) maintenance therapy fails, patients require renal replacement therapy (RRT) to survive, such as peritoneal dialysis (PD), hemodialysis, and renal transplantation. The most common therapy in Mexico is PD because it is a feasible, low-cost, and easy-to-perform procedure; however, fluid overload is a frequent condition in patients with this RRT modality.The usual adverse comorbidities in patients with PD are cardiovascular diseases (CVD) associated to atherosclerosis, uremia, inflammation, and oxidative stress. Fluid overload is intimately associated to hypertension, left ventricular hypertrophy, heart failure, and worsening of kidney failure, leading to increased hospital admissions, higher cardiovascular mortality, and reduced life expectancy. Two main pathologies are involved in the deterioration of both heart and kidney functions, namely, cardiorenal syndrome and uremic cardiomyopathy. Along with these phenomena, patients in PD with rapid peritoneal transport have reduced ultrafiltration, increased glucose absorption, and albumin loss in the dialysate, which lead to overhydration, hypertension, dyslipidemia, and malnutrition. This review focuses on the clinical, physiological, and biochemical mechanisms involved in fluid overload of patients with CKD undergoing PD.

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Protective measures against ultrafiltration failure in peritoneal dialysis patients

Cited by 11 publications

References 101 publications

The relationship between vascular endothelial growth factor (VEGF) in the serum and drained dialysate with the quality of peritoneal dialysis and peritoneal membrane transport rates

The relationship between vascular endothelial growth factor (VEGF) in the serum and drained dialysate with the quality of peritoneal dialysis and peritoneal membrane transport rates

Targeting Toll-like receptors with soluble Toll-like receptor 2 prevents peritoneal dialysis solution–induced fibrosis

Fluid Overload in Peritoneal Dialysis

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