Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan

Mesenteric elasticity assessed by shear wave elastography and its relationship with peritoneal function in peritoneal dialysis patients

Background

We evaluated the mesenteric elasticity in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using shear wave elastography (SWE) and investigated its relationships with peritoneal function.

Methods

Patients were recruited in our peritoneal dialysis (PD) centre between 15 July 2019 and 31 December 2021 and followed up to 31 March 2022. Twelve chronic kidney disease (CKD) patients and nineteen healthy people were included as controls. Correlation, linear regression and Cox regression analyses were applied.

Results

Of the 218 PD patients, 104 (47.8%) were male. Their mean age was 48.0 ± 13.2 years and the median PD duration was 59.0 months [interquartile range (IQR) 17.0-105]. The median mesenteric SWE value was 8.15 kPa (IQR 5.20-16.1). The mesenteric SWE values of patients with a PD duration of <3 months [5.20 kPa (IQR 3.10-7.60)] were not significantly different from those of CKD patients [4.35 kPa (IQR 2.63-5.20), P = .17] and healthy controls [3.60 kPa (IQR 2.90-5.10), P = .13] but were lower than those of patients with a PD duration of 3 months-5 years [6.40 kPa (IQR 4.10-10.5), P < .001], 5-10 years [11.9 kPa (IQR 7.40-18.2), P < .001] and >10 years [19.3 kPa (IQR 11.7-27.3), P < .001]. Longer PD duration (β = 0.58, P < .001), high effluent interleukin-6 (β = 0.61, P = .001) and low effluent cancer antigen 125 (β = -0.34, P = .03) were independently associated with low mesenteric elasticity. The mesenteric SWE value was independently correlated with the dialysate:plasma creatinine ratio (β = 0.39, P = .01) and negatively correlated with the total daily fluid volume removed (β = -0.17, P = .03). High mesenteric SWE values were an independent risk factor for death-censored technique failure [adjusted hazard ratio 4.14 (95% confidence interval 1.25-13.7), P = .02).

Conclusions

SWE could be used to non-invasively characterize peritoneal textural changes, which were closely associated with changes in peritoneal function.

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.