Key words: advanced glycation end product; continuBackground. Ultra-filtration failure is a serious com-ous ambulatory peritoneal dialysis; peritoneal fibrosis; plication of long-term continuous ambulatory periton-ultra-filtration failure; vascular changes eal dialysis (CAPD). This complication is related to histological changes of the peritoneum, i.e. severe interstitial fibrosis and microvascular sclerosis. Although their pathogenesis has not been elucidated yet, advanced glycation end products (AGEs) have Introduction been shown to accumulate in the peritoneal tissue of CAPD patients.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][4][5][6]. Recently, several reports semi-quantitatively evaluated. Peritoneal ultra-filtration have disclosed AGE accumulation in sera and tissues capacity was evaluated by calculating daily ultraof 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][8][9][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 microcentration 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 progressionWe recently described the marked peritoneal vascular of interstitial fibrosis (r=0.727, P=0.0088) and vaschanges in CAPD patients with ultra-filtration failure, cular sclerosis (r=0.915, P=0.001). UFV/BW was ini.e. severe fibrosis and hyalinization of the media of versely correlated to interstitial fibrosis (r=-0.660, small venules [13]. The present study was designed to P=0.0174), microvascular sclerosis (r=-0.671, evaluate the contribution of AGE in the development P=0.0155) and microvascular AGE accumulation of peritoneal lesions associated with ultra-filtration (r=-0.678, P=0.0145).failure. Semi-quantitative analysis disclosed that the Conclusions. In CAPD patients, AGE formation in severity of peritoneal changes were positively correlated the peritoneum correlates w...

The average peritoneal thickness and lumen/vessel diameter ratio were useful morphologic parameters to quantify the severity of the peritoneal alterations in uremic and peritoneal dialysis patients. Uremia and diabetes had an impact on the pathogenesis of peritoneal sclerosis in pre-peritoneal dialysis peritoneum. Peritoneal dialysis treatment itself had a much stronger impact on the progression of peritoneal sclerosis.