Peritoneal Dialysis Vintage and Glucose Exposure but Not Peritonitis Episodes Drive Peritoneal Membrane Transformation During the First Years of PD.

Authors:
Maria Bartosova
Maria Bartosova
Center for Pediatric and Adolescent Medicine
Finland
Betti Schaefer
Betti Schaefer
Center for Pediatric and Adolescent Medicine
Monroe | United States
Karel Vondrak
Karel Vondrak
University Hospital Motol
Czechia
Peter Sallay
Peter Sallay
Methodist Sports Medicine Center
Indianapolis | United States
Christina Taylan
Christina Taylan
Children's and Adolescents' Hospital
New Kent | United States
Rimante Cerkauskiene
Rimante Cerkauskiene
Vilnius University
Maria Dzierzega
Maria Dzierzega
Medicine Children's University Hospital
Chongqing | China

Front Physiol 2019 2;10:356. Epub 2019 Apr 2.

Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.

The impact of peritoneal dialysis (PD) associated peritonitis on peritoneal membrane integrity is incompletely understood. Children are particularly suited to address this question, since they are largely devoid of preexisting tissue damage and life-style related alterations. Within the International Peritoneal Biobank, 85 standardized parietal peritoneal tissue samples were obtained from 82 children on neutral pH PD fluids with low glucose degradation product (GDP) content. 37 patients had a history of peritonitis and 16 of the 37 had two or more episodes. Time interval between tissue sampling and the last peritonitis episode was 9 (4, 36) weeks. Tissue specimen underwent digital imaging and molecular analyses. Patients with and without peritonitis were on PD for 21.0 (12.0, 36.0) and 12.8 (7.3, 27.0) months ( = 0.053), respectively. They did not differ in anthropometric or histomorphometric parameters [mesothelial coverage, submesothelial fibrosis, blood, and lymphatic vascularization, leukocyte, macrophage and activated fibroblast counts, epithelial-mesenchymal transition (EMT), podoplanin positivity and vasculopathy]. VEGF and TGF-ß induced pSMAD abundance were similar. Similar findings were also obtained after matching for age and PD vintage and a subgroup analysis according to time since last peritonitis (<3, <6, >6 months). In patients with more than 24 months of PD vintage, submesothelial thickness, vessel number per mmm section length and ASMA fibroblast positivity were higher in patients with peritonitis history; only the difference in ASMA positivity persisted in multivariable analyses. While PD duration and EMT were independently associated with submesothelial thickness, and glucose exposure and EMT with peritoneal vessel density in the combined groups, submesothelial thickness was independently associated with EMT in the peritonitis free patients, and with duration of PD in patients with previous peritonitis. This detailed analysis of the peritoneal membrane in pediatric patients on PD with neutral pH, low GDP fluids, does not support the notion of a consistent long-term impact of peritonitis episodes on peritoneal membrane ultrastructure, on inflammatory and fibrotic cell activity and EMT. Peritoneal alterations are mainly driven by PD duration, dialytic glucose exposure, and associated EMT.

Download full-text PDF

Source
http://dx.doi.org/10.3389/fphys.2019.00356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6455046PMC
April 2019
1 Read

Article Mentions


Provided by Crossref Event Data
twitter
Twitter:
April 8, 2019, 2:37 am EST
twitter
Twitter:
April 6, 2019, 7:00 pm EST

Publication Analysis

Top Keywords

peritonitis episodes
8
peritoneal dialysis
8
peritoneal membrane
8
peritoneal
6
peritonitis
6
molecular analyses
4
analyses patients
4
digital imaging
4
specimen underwent
4
underwent digital
4
patients peritonitis
4
imaging molecular
4
peritonitis 210
4
270 months
4
months 0053
4
0053 differ
4
128 270
4
360 128
4
210 120
4
120 360
4

References

(Supplied by CrossRef)
The longitudinal effect of a single peritonitis episode on peritoneal membrane transport in CAPD patients.
Ates et al.
Perit. Dial. Int. 2000
CEM: coarsened exact matching in stata.
Blackwell et al.
Stata J. 2009

Similar Publications