An Autopsy Study of the Peritoneal Cavity From Patients on Continuous Ambulatory Peritoneal Dialysis

Rubin, Jack; Herrera, Guillermo A.; Collins, David L.

doi:10.1016/s0272-6386(12)80297-6

Cited by 99 publications

(59 citation statements)

References 14 publications

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“…A number of authors attempted to address the relationship between morphologic changes and specific clinical events. In an autopsy study, Rubin et al [18] demonstrated that chronic changes in the peritoneal 'serosa' were correlated with the number of episodes of peritonitis.…”

Section: Structural Alterations In Long-term Peritoneal Dialysismentioning

confidence: 99%

Recent Concepts in the Molecular Biology of the Peritoneal Membrane – Implications for More Biocompatible Dialysis Solutions

Mortier

Vriese²,

Lameire³

2003

Blood Purif

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This paper reviews some important recent findings on the molecular biology of the peritoneal membrane. It attempts to correlate in vitro and in vivo experimental results with the possible clinical consequences. The most common functional alteration during long-term CAPD is increased peritoneal small-solute transport rate, resulting in impaired ultrafiltration and decreased dialysis efficiency. This contribution first discusses the most relevant advances in the biochemistry and molecular biology of the peritoneal membrane following peritonitis and as consequence of the continuous exposure to unphysiological dialysis fluids. In a second part the preliminary experimental and clinical experience with more biocompatible fluids is summarized. The most relevant structural and functional alterations of the membrane following repeated peritonitis is the consequence of the response of the peritoneum to infective organisms involving the inflammatory cytokines and the interaction between membrane resident cell populations: macrophages, mesothelial cells and fibroblasts. In this setting, human biopsy studies and animal experiments have identified an increase in the peritoneal-associated vasculature, which seems to be the primary cause of increased solute transport. The structural and functional alterations in the membrane in long-term peritoneal dialysis are thought to be the consequence of the toxicity of glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end-products. In particular, an important role for vascular endothelial growth factor and nitric oxide as downstream mediators of the alterations has been suggested. Finally, the last part of this paper reviews the actual and future research aimed at an amelioration of the biocompatibility of the dialysis fluids. Replacing glucose by other osmotic agents, changing the sterilization process, replacing the lactate buffer by bicarbonate, blocking the formation of reactive carbonyl products and of the neoangiogenesis are the most promising changes to enhance the biocompatibility. Finally, gene therapy may in the future have an important contribution. Ex vivo gene therapy involves harvesting peritoneum samples to isolate mesothelial cells that will be genetically modified before re-implantation into the peritoneal cavity.

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Section: Structural Alterations In Long-term Peritoneal Dialysismentioning

confidence: 99%

Recent Concepts in the Molecular Biology of the Peritoneal Membrane – Implications for More Biocompatible Dialysis Solutions

Mortier

Vriese²,

Lameire³

2003

Blood Purif

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“…A comprehensive review of peritoneal membrane changes in long-term PD patients was recently published in the Atlas of Peritoneal Histology [Perit Dial Int 2000;20(suppl 3)]. The mechanisms responsible for these structural changes remain unknown at present, however, it has been suggested that these alterations might be related to the number of peritonitis episodes [35] and/or the time on PD treatment [47]. Loss of dialytic peritoneal membrane function may, however, also occur without a relevant histopathological correlate, suggesting that even mild structural abnormalities of the peritoneal membrane and/or subtle changes of peritoneal membrane cell function can be clinically relevant.…”

Section: Introductionmentioning

confidence: 99%

Glucose Degradation Products in Peritoneal Dialysis: From Bench to Bedside

Jörres

2003

Kidney Blood Press Res

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In continuous ambulatory peritoneal dialysis patients, treatment success is inextricably linked to the functional and morphological integrity of the peritoneal membrane. This membrane, however, is repeatedly exposed to peritoneal dialysis fluids (PDFs) with unphysiological composition (e.g., acidic pH, high glucose content, hyperosmolarity). More recently, attention of researchers and clinicians has been focused on the presence of glucose degradation products (GDPs) that are generated during heat sterilization of PDF. These GDPs were found to adversely affect peritoneal cell function both acutely and chronically. Recently, a new family of multi-chambered PDFs has been introduced into clinical practice. By keeping the glucose in a separate compartment at very low pH, the generation of GDPs during heat sterilization is markedly reduced. Initial clinical studies indicate that treatment with these novel PDFs may lead to improved clinical outcomes. The current article reviews recent experimental and clinical experience with both conventional and multi-chambered PDFs.

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“…Although the mechanism(s) underlying these alterations is (are) not completely known, cytokines and growth factors released by mesothelial cells and macrophages are proposed in the pathogenesis. [1][2][3][4][5][6][7][8] To eliminate the deleterious effects of long-term PD on peritoneal function and structure, many agents including valsartan, lisinopril, enalapril, and octreotide were tried yielding some beneficial outcomes. [9][10][11] Statins are generally prescribed to treat hyperlipidemia; however, data concerning anti-inflammatory, antiproliferative, and antioxidant effects of statins are accumulating.…”

Section: Introductionmentioning

confidence: 99%

Effects of atorvastatin on development of peritoneal fibrosis in rats on peritoneal dialysis

Yeniçerioğlu¹,

Üzelce²,

Akar³

et al. 2010

Renal Failure

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Rational: Peritoneal sclerosis is one of the important complications of long-term peritoneal dialysis (PD). In this study, efficacy of atorvastatin on peritoneal histology and functions in non-uremic rats on PD was tested. Objectives: Twenty-two non-uremic Wistar albino rats were randomized into three groups: Sham (intraperitoneal saline), peritoneal dialysis (PD, intraperitoneal 3.86% dextrose containing PD solution), and treatment (TX, intraperitoneal 3.86% dextrose containing PD solution plus atorvastatin added into drinking water). At the end of a 4-week period, 1 h peritoneal equilibration test was performed. Serum lipids and certain cytokines, mediators, markers, and antioxidant enzyme activities in serum and dialysate were studied. Peritoneal thickness was measured and peritoneal inflammation, fibrosis, and vascular proliferation were scored in histological sections. Main findings: In histological examinations, inflammation, fibrosis, and vascular proliferation were significantly more frequent in PD group than Sham group and it seemed to decrease significantly when atorvastatin was used in conjunction with PD. Additionally, peritoneum was significantly thicker in PD group when compared to that of Sham and TX groups. Serum parameters did not significantly differ between groups. On the other hand, dialysate glutathione reductase (GR) activity and TGF-b were significantly lower in TX group than that of the PD group, whereas dialysate IL-6 level was higher in TX group. Principal conclusions: In our study, atorvastatin use appeared to diminish structural changes in peritoneum. Decreased expression of TGF-b in dialysate may be one of the possible underlying mechanisms.

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An Autopsy Study of the Peritoneal Cavity From Patients on Continuous Ambulatory Peritoneal Dialysis

Cited by 99 publications

References 14 publications

Recent Concepts in the Molecular Biology of the Peritoneal Membrane – Implications for More Biocompatible Dialysis Solutions

Recent Concepts in the Molecular Biology of the Peritoneal Membrane – Implications for More Biocompatible Dialysis Solutions

Glucose Degradation Products in Peritoneal Dialysis: From Bench to Bedside

Effects of atorvastatin on development of peritoneal fibrosis in rats on peritoneal dialysis

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