Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan

Abstract

The thin peritoneum covering the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) because it is highly vascularized and has a large body surface area. However, it has been reported that peritoneal membranes affected by peritonitis, as well as those exposed to the nonphysiological high glucose levels containing PD dialysate, may undergo histological and functional changes. Patients undergoing PD may experience encapsulating peritoneal sclerosis (EPS), which is a life-threatening serious complication of PD that can significantly impair activities of daily living. The incidence of EPS was 1.4–7.3% of maintenance PD patients in the 1980s. The incidence has improved to 1.0% after a neutral dialysate became the standard PD treatment in Japan. Furthermore, the pathogenesis of EPS is uncertain although its onset may be explained by the “two-hit theory,” in which some factors leading to impairment had an additive effect on simple peritoneal sclerosis. The evaluation of histopathological findings has shown the impact of the neutral dialysate on peritoneal deterioration as well as its role in the development of functional changes. In the present report, we discuss the advances in the understanding of peritoneal deterioration based on histological and macroscopic evaluations of the peritoneum of patients undergoing PD. We also discuss the recent treatment for PD patients.

Histopathological Changes of Long-Term Peritoneal Dialysis Using Physiological Solutions: A Case Report and Review of the Literature

“…The contribution of the daytime dwells with icodextrin, which has a low pH but gives the peritoneum a break from glucose exposure for multiple hours of the day, is unclear. In Japan, the incidence of EPS decreased from 7.3 to 1.4% of maintenance PD patients in the 1980s to 1.0% in recent years after the introduction of pH neutral physiologic PD solutions [34]. Unfortunately, physiologic PD solutions are not widely available to all children/adolescents with ESKD, for instance, not in the USA [35].…”

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

“…Four stages of EPS have been classified [ 67 ]: stage 1 (pre-EPS), stage 2 (inflammatory), stage 3 (encapsulating), and stage 4 (chronic) [ 68 ]. An abdominal CT scan is the main imaging modality used to diagnose EPS [ 69 ].…”

Mesenteric elasticity assessed by shear wave elastography and its relationship with peritoneal function in peritoneal dialysis patients

“…The thin, highly vascularized peritoneum that encloses the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) [ 1 ]. The morphological integrity and functional stability of the peritoneum are critical for efficient dialysis and the survival of patients undergoing maintenance PD [ 2 ].…”