This study examined the morphologic features of the parietal peritoneal membranes of 130 patients undergoing peritoneal dialysis (PD) and compared them with the features of the peritoneal membranes of normal individuals, uremic predialysis patients, and patients undergoing hemodialysis. The median thickness of the submesothelial compact collagenous zone was 50 µm for normal subjects, 140 µm for uremic patients, 150 µm for patients undergoing hemodialysis, and 270 µm for patients undergoing PD (P 97 mo, 700 µm (n = 19)]. Vascular changes included progressive subendothelial hyalinization, with luminal narrowing or obliteration. These changes were absent in samples from normal subjects but were present in 28% of samples from uremic patients and 56% of biopsies from patients undergoing PD. In the PD group, the prevalence of vasculopathy increased significantly with therapy duration (P = 0.0001). The density of blood vessels per unit length of peritoneum was significantly higher for patients with membrane failure and was correlated with the degree of fibrosis (P = 0.01). For the first time, a comprehensive cross-sectional analysis of the morphologic changes in the peritoneal membranes of patients undergoing PD is provided. The infrequency of fibrosis in the absence of vasculopathy suggests that vasculopathy may predispose patients to the development of fibrosis. This study provides a sufficiently large cohort of samples to allow structure-function relationships to be established, as well as providing a repository of tissue for further studies.

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Morphologic Changes in the Peritoneal Membrane of Patients with Renal Disease

https://www.kidney-international.org/article/S0085-2538(15)50044-6/pdf

The Euro-Balance Trial: the effect of a new biocompatible peritoneal dialysis fluid (balance) on the peritoneal membrane

ObjectiveTo analyze morphological changes in the peritoneum of peritoneal sclerosis (PS) patients. Emphasis was put on vascular abnormalities, because the continuous exposure to glucose-based dialy...

Vascular and interstitial changes in the peritoneum of CAPD patients with peritoneal sclerosis

Advanced glycation end products (AGEs) are formed Methods Peritoneal biopsy specimens from 14 CAPD by a non-enzymatic reaction between reduced sugar patients with low ultra-filtration (n=9) and high ultra- and protein, known as the Maillard reaction [1,2] filtration (n=5) capacity were immunohistochemically AGEs accumulate on serum proteins and various tissue investigated using a monoclonal antibody against AGEs proteins in patients with diabetes mellitus (DM ), sug(6D12) The severity of peritoneal fibrosis, microvascu- gesting that they play a role in the pathogenesis of lar sclerosis and intensity of AGE accumulation were diabetic complications [3‐6 ] Recently, several reports semi-quantitatively evaluated Peritoneal ultra-filtration have disclosed AGE accumulation in sera and tissues capacity was evaluated by calculating daily ultra- of chronic renal failure (CRF ) patients, irrespective of filtration volume per body weight ( UFV/BW ) and D/D 0 the presence or absence of DM [7‐10] In CRF (glucose) of the peritoneal equilibration test patients, AGEs are formed due to high oxidative stress Results In all patients with low ultra-filtration, AGE associated with the uraemic state [11] The high conaccumulated in the peritoneal fibrous tissue and micro- centration of glucose in the peritoneal dialysate of vascular walls Remarkably, AGE accumulated more continuous ambulatory peritoneal dialysis (CAPD) intensely in hyalinized fibrosis of small venular media patients has been shown to facilitate AGE formation Extent of AGE accumulation in peritoneal interstitium in the peritoneal membrane [9,12] and vascular walls correlated with the progression We recently described the marked peritoneal vascular of interstitial fibrosis (r=0727, P=00088) and vas- changes in CAPD patients with ultra-filtration failure, cular sclerosis (r=0915, P=0001) UFV/BW was in- ie severe fibrosis and hyalinization of the media of versely correlated to interstitial fibrosis (r=‐0660, small venules [13] The present study was designed to P=00174), microvascular sclerosis (r=‐0671, evaluate the contribution of AGE in the development P=00155) and microvascular AGE accumulation of peritoneal lesions associated with ultra-filtration (r=‐0678, P=00145) failure Semi-quantitative analysis disclosed that the Conclusions In CAPD patients, AGE formation in severity of peritoneal changes were positively correlated the peritoneum correlates with the development of with the grade of AGE accumulation Furthermore, severe interstitial fibrosis and microvascular sclerosis, which is associated clinically with impaired peritoneal an inverse relationship between peritoneal ultraultra-filtration filtration capacity represented by daily ultra-filtration volume per body weight ( UFV/BW ) and histological changes was also observed In addition, the pathogen

Accumulation of advanced glycation end products in the peritoneal vasculature of continuous ambulatory peritoneal dialysis patients with low ultra-filtration.

https://www.kidney-international.org/article/S0085-2538(15)47472-1/pdf

Aiichiro Ogawa

Papers

Immunohistochemical detection of advanced glycosylation end-products in the peritoneum and its possible pathophysiological role in CAPD.