Effects of Low Glucose Degradation Products Peritoneal Dialysis Fluid on the Peritoneal Fibrosis and Vascularization in a Chronic Rat Model

Kim, Chan Duck; Kwon, Hyeog Man; Oh, Eun Joo; Kim, Mi Hyung; Choi, Sungmoon; Choi, Min Jeong; Kim, In San; Park, Min Sun; Kim, Yong Jin; Kim, Yong Lim

doi:10.1111/j.1744-9987.2007.00431.x

Cited by 28 publications

(19 citation statements)

References 15 publications

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“…Animal models have shown the benefit of using fluids low in glucose degradation products (compared with conventional fluids) in terms of vasculopathy and fibrosis (27). We recognize that, in clinical studies, it is difficult to show the specific and separate effect of glucose content because of the generally unavoidable coincidence between high glucose use and peritoneal FT. To try to clarify that issue, we explored the influence of HGE on peritoneal transport only during year 1 in the group of patients with intermediate permeability.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Initial Peritoneal Transport Characteristics, Inflammation, and High Glucose Exposure on Prognosis for Peritoneal Membrane Function

Bajo

Peso

et al. 2012

Perit Dial Int

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♦ BackgroundFast transport status, acquired with time on peritoneal dialysis (PD), is a pathology induced by peritoneal exposure to bioincompatible solutions. Fast transport has important clinical consequences and should be prevented.♦ ObjectiveWe analyzed the repercussions of initial peritoneal transport characteristics on the prognosis for peritoneal membrane function, and also whether the influence of peritonitis and high exposure to glucose are different according to the initial peritoneal transport characteristics or the moment when such events occur.♦ MethodsThe study included 275 peritoneal dialysis patients with at least 2 peritoneal function studies (at baseline and 1 year). Peritoneal kinetic studies were performed at baseline and annually. Those studies consist of a 4-hour dwell with glucose (1.5% during 1981 – 1990, and 2.27% during 1991 – 2002) to calculate the peritoneal mass transfer coefficients of urea and creatinine (milliliters per minute) using a previously described mathematical model.♦ ResultsMembrane prognosis and technique survival were independent of baseline transport characteristics. Fast transport and ultrafiltration (UF) failure are reversible conditions, provided that peritonitis and high glucose exposure are avoided during the early dialysis period. The first year on PD is a main determining factor for the membrane's future, and the mass transfer coefficient of creatinine at year 1 is the best functional predictor of future PD history. After 5 years on dialysis, permeability frequently increases, and UF decreases. Icodextrin is associated with peritoneal protection.♦ ConclusionsPeritoneal membrane prognosis is independent of baseline transport characteristics. Intrinsic fast transport and low UF are reversible conditions when peritonitis and high glucose exposure are avoided during the early dialysis period. Icodextrin helps in glucose avoidance and is associated with peritoneal protection.

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Section: Discussionmentioning

confidence: 99%

The Influence of Initial Peritoneal Transport Characteristics, Inflammation, and High Glucose Exposure on Prognosis for Peritoneal Membrane Function

Bajo

Peso

et al. 2012

Perit Dial Int

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“…The GDPs and AGEs may damage peritoneal cells and proteins through various mechanisms (22)(23)(24)(25)(26)(27)(28), leading to peritoneal damage. It has become increasingly clear that, in animal models of PD, the more-biocompatible peritoneal dialysates (bicarbonate/lactate buffer, low GDPs) induce less damage and less impairment of ultrafiltration (16,19,29,30). In addition, supplementing peritoneal dialysate with aminoguanidine, which scavenges GDPs and prevents AGE formation, results in less mesothelial denudation (31), fibrosis, and angiogenesis in omentum and parietal peritoneum (32).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Ayuzawa¹,

Ishibashi

Takazawa³

et al. 2012

Perit Dial Int

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♦ Background: Morphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported. ♦ Objective: The aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy. ♦ Methods: We evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.

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“…The thickness of the parietal membrane and the number of vessels in omental tissues were assessed as previously described by our group [12]. To assess the number of vessels, omental tissues were stained with anti-von-Willebrand-factor antibody (1:500; Abcam, Cambridge, Mass., USA).…”

Section: Methodsmentioning

confidence: 99%

“…Peritoneal membrane permeability was assessed by calculating the dialysate-to-plasma water sodium ratio (D/P Na ). The glucose mass transfer (GMT) of the peritoneum was calculated using the following formula: (initial dialysate glucose × initial infusion volume) – (final dialysate glucose × final drain volume) [12]. …”

Section: Methodsmentioning

confidence: 99%

“…VEGF induces increased vascular proliferation and membrane hyperpermeability [10]. Our group reported that GDP-containing PDF increases VEGF production and induces both peritoneal fibrosis and vascularization in a chronic infusion model of peritoneal dialysis in the rat [11,12]. However, there is no evidence that GDP-containing PDF is directly related to EMT in the peritoneal membrane.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Low Glucose Degradation Product Bicarbonate/Lactate-Buffered Dialysis Solution on the Epithelial-Mesenchymal Transition of Peritoneum

Oh¹,

Ryu²,

Choi³

et al. 2009

Am J Nephrol

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Background: Epithelial-mesenchymal transition (EMT) is important in the development of peritoneal fibrosis. Glucose degradation products (GDPs) may induce EMT in human peritoneal mesothelial cells (HPMCs). Methods: The effects of individual GDPs and GDPs derived from peritoneal dialysis fluid (PDF) in both HPMCs and peritoneal membranes were evaluated. EMT was assessed with α-smooth muscle actin (α-SMA) and E-cadherin. Results: In vitro, α-SMA protein and mRNA levels increased in the presence of the GDPs (formaldehyde, glyoxal, methylglyoxal, and 3-deoxyglucosone), and E-cadherin decreased. Changes in the EMT markers were most prominent after exposure to 3-deoxyglucosone. Changes in both α-SMA and E-cadherin protein levels were less with low (L)-GDP bicarbonate/lactate-buffered PDF compared to high (H)-GDP PDF. In the rat model after 8 weeks’ PDF infusion, the α-SMA/E-cadherin mRNA ratio increased in the H-GDP group compared with the L-GDP group (p < 0.05). The peritoneum in the H-GDP group tended to be thicker (p = 0.052) and had more blood vessels than that in the L-GDP group (p < 0.05). Tissue staining for TGF-β1 decreased in the L-GDP group. Dual-stained cytokeratin and α-SMA-positive myofibroblasts in the submesothelial layer were more prominent in the H-GDP group. Conclusion: GDPs found in PDF induce EMT of HPMCs, which is associated with peritoneal fibrosis and vascularization. Conversely, L-GDP PDF reduces EMT and peritoneal fibrosis.

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Effects of Low Glucose Degradation Products Peritoneal Dialysis Fluid on the Peritoneal Fibrosis and Vascularization in a Chronic Rat Model

Cited by 28 publications

References 15 publications

The Influence of Initial Peritoneal Transport Characteristics, Inflammation, and High Glucose Exposure on Prognosis for Peritoneal Membrane Function

The Influence of Initial Peritoneal Transport Characteristics, Inflammation, and High Glucose Exposure on Prognosis for Peritoneal Membrane Function

Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Impact of Low Glucose Degradation Product Bicarbonate/Lactate-Buffered Dialysis Solution on the Epithelial-Mesenchymal Transition of Peritoneum

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