1
|
Masola V, Bonomini M, Onisto M, Ferraro PM, Arduini A, Gambaro G. Biological Effects of XyloCore, a Glucose Sparing PD Solution, on Mesothelial Cells: Focus on Mesothelial-Mesenchymal Transition, Inflammation and Angiogenesis. Nutrients 2021; 13:2282. [PMID: 34209455 PMCID: PMC8308380 DOI: 10.3390/nu13072282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
Glucose-based solutions remain the most used osmotic agents in peritoneal dialysis (PD), but unavoidably they contribute to the loss of peritoneal filtration capacity. Here, we evaluated at a molecular level the effects of XyloCore, a new PD solution with a low glucose content, in mesothelial and endothelial cells. Cell viability, integrity of mesothelial and endothelial cell membrane, activation of mesothelial and endothelial to mesenchymal transition programs, inflammation, and angiogenesis were evaluated by several techniques. Results showed that XyloCore preserves mesothelial and endothelial cell viability and membrane integrity. Moreover XyloCore, unlike glucose-based solutions, does not exert pro-fibrotic, -inflammatory, and -angiogenic effects. Overall, the in vitro evidence suggests that XyloCore could represent a potential biocompatible solution promising better outcomes in clinical practice.
Collapse
Affiliation(s)
- Valentina Masola
- Division of Nephrology and Dialysis, Department of Medicine, Piazzale A. Stefani 1, 37126 Verona, Italy;
- Department of Biomedical Sciences, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy;
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University, Chieti-Pescara, SS.Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy;
| | - Maurizio Onisto
- Department of Biomedical Sciences, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy;
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00178 Rome, Italy;
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00178 Rome, Italy
| | - Arduino Arduini
- R&D Department, Iperboreal Pharma Srl, 65122 Pescara, Italy;
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, Piazzale A. Stefani 1, 37126 Verona, Italy;
| |
Collapse
|
2
|
Abstract
♦ Background The introduction of peritoneal dialysis (PD) as a modality of renal replacement therapy has provoked much interest in the biology of the peritoneal mesothelial cell. Mesothelial cells isolated from omental tissue have immunohistochemical markers that are identical to those of mesothelial stem cells, and omental mesothelial cells can be cultivated in vitro to study changes to their biologic functions in the setting of PD. ♦ Method The present article describes the structure and function of mesothelial cells in the normal peritoneum and details the morphologic changes that occur after the introduction of PD. Furthermore, this article reviews the literature of mesothelial cell culture and the limitations of in vitro studies. ♦ Results The mesothelium is now considered to be a dynamic membrane that plays a pivotal role in the homeostasis of the peritoneal cavity, contributing to the control of fluid and solute transport, inflammation, and wound healing. These functional properties of the mesothelium are compromised in the setting of PD. Cultures of peritoneal mesothelial cells from omental tissue provide a relevant in vitro model that allows researchers to assess specific molecular pathways of disease in a distinct population of cells. Structural and functional attributes of mesothelial cells are discussed in relation to long-term culture, proliferation potential, age of tissue donor, use of human or animal in vitro models, and how the foregoing factors may influence in vitro data. ♦ Conclusions The ability to propagate mesothelial cells in culture has resulted, over the past two decades, in an explosion of mesothelial cell research pertaining to PD and peritoneal disorders. Independent researchers have highlighted the potential use of mesothelial cells as targets for gene therapy or transplantation in the search to provide therapeutic strategies for the preservation of the mesothelium during chemical or bacterial injury.
Collapse
Affiliation(s)
- Susan Yung
- Department of Medicine, University of Hong Kong, Hong Kong SAR, PR China
| | - Chan Tak Mao
- Department of Medicine, University of Hong Kong, Hong Kong SAR, PR China
| |
Collapse
|
3
|
Abstract
During peritoneal dialysis, peritoneal cells are repeatedly exposed to a non-physiologic hypertonic environment with high glucose content and low pH. Current sterile dialysis solutions cause inflammation in the submesothelial compact zone, leading to fibrosis, angiogenesis, and, eventually, ultrafiltration failure. Although the normal interstitium separates the peritoneal microvasculature from the dialysis fluid and makes transperitoneal transport less efficient, changes in the submesothelial compact zone can result in progressive increases in solute transfer and ultrafiltration diminution. This peritoneal dysfunction will further be amplified with the development of an epithelial-to-mesenchymal transition of mesothelial cells and dissipation of the osmotic driving force through the increased area and solute transport that accompany neoangiogenesis of the submesothelial microvasculature. The alteration of the peritoneal membrane can be further aggravated by peritonitis, advanced glycation end-products, and glucose degradation products. Furthermore, new data are emerging to support a proinflammatory role for peritoneal adipocytes.
Collapse
Affiliation(s)
- Kar Neng Lai
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, PR China
| | - Sydney C.W. Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, PR China
| | - Joseph C.K. Leung
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, PR China
| |
Collapse
|
4
|
Abstract
Peritoneal fibrosis (PF) is an important issue in peritoneal dialysis (PD) because it remains one of the leading causes of patient drop-out from PD. In this review, we focus on in vitro approaches to the pathogenesis and therapeutic potential of PF and on associated clinical implications. Representative Asian studies, initiated since mid-1990s, that have investigated matrix accumulation in peritoneal tissue possibly leading to PF in the PD population will be highlighted as examples to learn how to apply this research tool. As compared with data from well-designed clinical trials, observations from in vitro models may be far from becoming solid evidence; however, they do cast new light on options for investigations into therapeutic pharmaceuticals.
Collapse
Affiliation(s)
- Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tun-Jun Tsai
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
5
|
Sánchez-Rodríguez C, Peiró C, Rodríguez-Mañas L, Nevado J. Polyphenols Attenuate Highly-Glycosylated Haemoglobin-Induced Damage in Human Peritoneal Mesothelial Cells. Antioxidants (Basel) 2020; 9:antiox9070572. [PMID: 32630324 PMCID: PMC7402166 DOI: 10.3390/antiox9070572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023] Open
Abstract
We investigated the cytoprotective role of the dietary polyphenols on putative damage induced by Amadori adducts in Human Peritoneal Mesothelial Cells (HPMCs). Increased accumulation of early products of non-enzymatic protein glycation-Amadori adducts-in the peritoneal dialysis fluid due to their high glucose, induces severe damage in mesothelial cells during peritoneal dialysis. Dietary polyphenols reportedly have numerous health benefits in various diseases and have been used as an efficient antioxidant in the context of several oxidative stress-related pathologies. HPMCs isolated from different patients were exposed to Amadori adducts (highly glycated haemoglobin, at physiological concentrations), and subsequently treated with several polyphenols, mostly presented in our Mediterranean diet. We studied several Amadori-induced effects in pro-apoptotic and oxidative stress markers, as well as the expression of several pro-inflammatory genes (nuclear factor-kappaB, NF-kB; inducible Nitric Oxide synthetase, iNOS), different caspase-activities, level of P53 protein or production of different reactive oxygen species in the presence of different polyphenols. In fact, cytoprotective agents such as dietary polyphenols may represent an alternate approach to protect mesothelial cells from the cytotoxicity of Amadori adducts. The interference with the Amadori adducts-triggered mechanisms could represent a therapeutic tool to reduce complications associated with peritoneal dialysis in the peritoneum, helping to maintain peritoneal membrane function longer in patients undergoing peritoneal dialysis.
Collapse
Affiliation(s)
- Carolina Sánchez-Rodríguez
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Correspondence: ; Tel.: +34-912-115-176
| | - Concepción Peiró
- Department of Pharmacology, School of Medicine, Instituto de Investigaciones Sanitarias IdiPAZ, Universidad Autónoma de Madrid, 28029 Madrid, Spain;
| | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Department of Geriatrics, Hospital Universitario de Getafe, 28905 Madrid, Spain;
| | - Julián Nevado
- Genomic and Molecular Nephropathy Sections, Instituto de Genética Médica y Molecular (INGEMM), IdiPaz-Hospital Universitario La Paz, y Centro de Investigación Básica en Red de Enfermedades Raras (CIBERER), 28046 Madrid, Spain;
| |
Collapse
|
6
|
Abstract
Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand, it is widely assumed that exposure of the peritoneal membrane to high glucose concentrations contributes to both structural and functional changes in the dialyzed peritoneal membrane. As in diabetes, glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end products, may contribute to peritoneal membrane failure. Although efforts to reduce glucose toxicity have been made for years, only a few suggestions, such as dual-bag systems with bicarbonate as buffer system, have found broader acceptance. Recently, some interesting new approaches to the problem of glucose-related toxicity have been made, but further investigations will be necessary before they can be used clinically. This review will focus on adverse effects of glucose in PD solutions and summarize different aspects of glucotoxicity and potential therapeutic interventions.
Collapse
Affiliation(s)
- Thomas Sitter
- Department of Nephrology, Medizinische Poliklinik–Innenstadt, Klinikum der Universität München, Germany
| | - Matthias Sauter
- Department of Nephrology, Medizinische Poliklinik–Innenstadt, Klinikum der Universität München, Germany
| |
Collapse
|
7
|
Park SH, Lee EG, Kim IS, Kim YJ, Cho DK, Kim YL. Effect of Glucose Degradation Products on the Peritoneal Membrane in a Chronic Inflammatory Infusion Model of Peritoneal Dialysis in the Rat. Perit Dial Int 2020. [DOI: 10.1177/089686080402400202] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Long-term use of the peritoneal membrane as a dialyzing membrane is hampered by its eventual deterioration. One of the contributing factors is glucose degradation products (GDPs) in the dialysis solution. In this study, we evaluated the effect of a low GDP solution on peritoneal permeability, the structural stability of the peritoneal membrane, and vascular endothelial growth factor (VEGF) production in a chronic inflammatory infusion model of peritoneal dialysis (PD) in the rat. Methods Male Sprague–Dawley rats were divided into 3 groups: a conventional solution group (group C, n = 12), a test solution group (group T, n = 12), and a normal control group (group NC, n = 8). Group T rats were infused with low GDP solution (2.3% glucose solution with two compartments), and group C rats with conventional dialysis solution (2.3% glucose solution), adjusted to pH 7.0 before each exchange. Animals were infused through a permanent catheter with 25 mL of dialysis solution. In both groups, peritoneal inflammation was induced by infusing dialysis solution supplemented with lipopolysaccharide on days 8, 9, and 10 after starting dialysate infusion. Peritoneal membrane function was assessed before and 6 weeks after initiating dialysis using the 1-hour peritoneal equilibration test (PET) employing 4.25% glucose solution. Both VEGF and transforming growth factor β1 (TGFβ1) in the dialysate effluent were measured by ELISA. The number of vessels in the omentum was counted after staining with anti-von Willebrand factor, and the thickness of submesothelial matrix of the trichrome-stained parietal peritoneum was measured. Peritoneal tissue was analyzed for VEGF protein using immunohistochemistry. Results At the end of 6 weeks, the rate of glucose transport (D/D0, where D is glucose concentration in the dialysate and D0 is glucose concentration in the dialysis solution before it is infused into the peritoneal cavity) was higher in group T ( p < 0.05) than in group C. Dialysate-to-plasma ratio (D/P) of protein was lower in group T ( p < 0.05) than in group C; D/Purea, D/Psodium, and drain volumes did not differ significantly between groups C and T. Dialysate VEGF and TGFβ levels were lower in group T ( p < 0.05) than in group C. Immunohistochemical studies also revealed less VEGF in the peritoneal membranes of group T. There were significantly more peritoneal blood vessels in group C ( p < 0.05) than in group T, but the thickness of submesothelial matrix of the parietal peritoneum was not different between the two groups. The VEGF levels in the dialysate effluent correlated positively with the number of blood vessels per field ( r = 0.622, p < 0.005). Conclusion Using a chronic inflammatory infusion model of PD in the rat, we show that dialysis with GDP-containing PD fluid is associated with increased VEGF production and peritoneal vascularization. Use of low GDP solutions may therefore be beneficial in maintaining the function and structure of the peritoneal membrane during long-term PD.
Collapse
Affiliation(s)
- Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, Daegu, Korea
| | - Eun-Gyui Lee
- Department of Biochemistry, Kyungpook National University, School of Medicine, Daegu, Korea
| | - In-San Kim
- Department of Biochemistry, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Yong-Jin Kim
- Department of Pathology, Yeungnam University, College of Medicine, Daegu, Korea
| | - Dong-Kyu Cho
- Division of Nephrology, Department of Internal Medicine, Daegu, Korea
| | - Yong-Lim Kim
- Division of Nephrology, Department of Internal Medicine, Daegu, Korea
| |
Collapse
|
8
|
Noh H, Ha H, Yu MR, Kim YO, Kim JH, Lee HB. Angiotensin II Mediates High Glucose-Induced TGF-β1 and Fibronectin Upregulation in HPMC through Reactive Oxygen Species. Perit Dial Int 2020. [DOI: 10.1177/089686080502500110] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective To demonstrate the presence of an independent renin–angiotensin system (RAS) in the peritoneum and to determine the role of locally produced angiotensin (Ang) II in high glucose-induced upregulation of transforming growth factor (TGF)-β1 and fibronectin by human peritoneal mesothelial cells (HPMC). Methods In cultured HPMC, the expression of mRNAs for angiotensinogen, angiotensin-converting enzyme (ACE), Ang II type 1 receptor (AT1), and TGF-β1 was evaluated by real-time polymerase chain reaction; ACE, AT1, and fibronectin proteins by Western blot analysis; and Ang I, Ang II, and TGF-β1 proteins by ELISA. Dichlorofluorescein (DCF)-sensitive cellular reactive oxygen species (ROS) were measured by fluorometry. Results HPMC constitutively expressed all the components of RAS, and 50 mmol/L D-glucose (high glucose) significantly increased angiotensinogen, ACE, and AT1 mRNAs and ACE, AT1, and Ang II proteins. Ang II increased TGF-β1 and fibronectin protein expression and DCF-sensitive cellular ROS. Losartan prevented Ang II-induced increase in cellular ROS. Both losartan and captopril inhibited high glucose-induced upregulation of TGF-β1 and fibronectin expression in HPMC in a dose-dependent manner. Antioxidant catalase and NADPH oxidase inhibitor diphenyleneiodinium effectively inhibited Ang II-induced TGF-β1 and fibronectin protein expression. Conclusions The present data demonstrate that HPMC constitutively express RAS, that Ang II produced by HPMC mediates high glucose-induced upregulation of TGF-β1 and fibronectin expression, and that Ang II-induced TGF-β1 and fibronectin expression in HPMC is mediated by NADPH oxidase-dependent ROS. These data suggest that locally produced Ang II and ROS in the peritoneum may be potential therapeutic targets in peritoneal fibrosis during long-term peritoneal dialysis.
Collapse
Affiliation(s)
- Hyunjin Noh
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Hunjoo Ha
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
- Ewha Womans University College of Pharmacy, Seoul, Korea
| | - Mi Ra Yu
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Young Ok Kim
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Ji Hye Kim
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
- BK21 Project for Medical Sciences, Yonsei University, Seoul, Korea
| | - Hi Bahl Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| |
Collapse
|
9
|
Abstract
Objective Peritoneal fibrosis is one of the most serious complications of peritoneal dialysis (PD). Peritoneal fibrosis is characterized by activation of the peritoneal resident cells, accumulation and deposition of excess matrix proteins within the interstitium, and neoangiogenesis and vasculopathy of the peritoneal microvasculature. Compelling evidence now exists to show that elevated glucose concentrations present as the osmotic agent in PD solutions are, per se, responsible for those detrimental changes. Until alternative osmotic agents can fully replace glucose in PD solutions, novel therapeutic strategies are essential to preserve the structural and functional properties of the peritoneum. This review highlights recent experimental data that may offer potential strategies for preservation of the peritoneal structure and improvement of clinical outcome. Method Literature review. Results Compelling evidence now exists to show that the bioincompatible nature of PD solutions—in particular, elevated glucose concentrations and glucose byproducts—play a pivotal role in the initiation of peritoneal fibrosis. Animal and in vitro studies provide some insight into methods that can potentially be employed to alleviate or retard peritoneal fibrosis. Those methods include use of alterative osmotic agents (polyglucose or amino acids), administration of TGFβ1 antagonists, gene therapy, and pharmacologic interventions. Conclusions Knowledge of the pathogenesis of peritoneal fibrosis has allowed independent researchers to design therapeutic strategies that abrogate excess matrix synthesis and deposition in cultured peritoneal cells and in animal models of experimental peritoneal fibrosis alike. Encouraging results have been obtained in those studies, but it remains to be determined whether the studied strategies can alleviate clinical disease. Future studies will enable us to establish specific molecules that can be targeted clinically to restrict the progressive deterioration of the peritoneal membrane as a biologic dialyzing organ.
Collapse
Affiliation(s)
- Susan Yung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tak-mao Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
10
|
Zareie M, van Lambalgen AA, Ter Wee PM, Hekking LH, Keuning ED, Schadee–Eestermans IL, Faict D, Degréve B, Tangelder GJ, Beelen RH, van den Born J. Better Preservation of the Peritoneum in Rats Exposed to Amino Acid-Based Peritoneal Dialysis Fluid. Perit Dial Int 2020. [DOI: 10.1177/089686080502500112] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Glucose-containing peritoneal dialysis fluids (PDF) show impaired biocompatibility, which is related partly to their high glucose content, presence of glucose degradation products, low pH, and lactate buffer, or a combination of these factors. In a rat chronic peritoneal exposure model, we compared effects of an amino acid-based PDF (AA-PDF) with a glucose-containing PDF on the peritoneal microcirculation and morphology. Method Two groups of rats received 10 mL of either fluid daily for 5 weeks via peritoneal catheters connected to implanted subcutaneous mini vascular access ports. Leukocyte–endothelium interactions in the mesenteric venules were investigated by intravital microscopy. Quantification of angiogenesis and fibrosis and inspection of the mesothelial cell layer were performed by light and electron microscopy. Results Daily exposure to glucose-containing PDF resulted in a significant increase in the number of rolling leukocytes in mesenteric venules, whereas instillation of AA-PDF did not change the level of leukocyte rolling. Glucose-containing PDF evoked a significantly higher number of milky spots in the omentum, whereas this response was significantly reduced in animals exposed to the AA-PDF ( p < 0.02). Chronic instillation of glucose-containing PDF induced angiogenesis in various peritoneal tissues, accompanied by fibrosis in the mesentery and parietal peritoneum. Quantitative morphometric evaluation of omentum and mesentery showed a clear trend toward less angiogenesis after treatment with the AA-PDF compared to the glucose-containing PDF, which reached statistical significance in the parietal peritoneum ( p < 0.04). Instillation of AA-PDF resulted in approximately 50% reduction of fibrosis in the mesentery ( p < 0.04) and approximately 25% reduction in the parietal peritoneum ( p < 0.009) compared to glucose-containing PDF. Glucose-containing PDF damaged the mesothelial cell layer, whereas the mesothelium was intact after AA-PDF treatment, as evidenced by electron microscopy. Conclusion Our data in a rat chronic peritoneal exposure model clearly demonstrate reduced immune activation (evidenced by decreased number of rolling leukocytes and decreased induction of omental milky spots) and reduced neoangiogenesis, fibrosis, and mesothelial damage of the peritoneal membrane after treatment with AA-PDF compared to glucose-containing PDF.
Collapse
Affiliation(s)
- Mohammad Zareie
- Department of Molecular Cell Biology,VU University Medical Center, Amsterdam, The Netherlands
| | | | - Piet M. Ter Wee
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Liesbeth H.P. Hekking
- Department of Molecular Cell Biology,VU University Medical Center, Amsterdam, The Netherlands
| | - Eelco D. Keuning
- Department of Molecular Cell Biology,VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Geert-Jan Tangelder
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert H.J. Beelen
- Department of Molecular Cell Biology,VU University Medical Center, Amsterdam, The Netherlands
| | - Jacob van den Born
- Department of Molecular Cell Biology,VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Martikainen TA, Teppo AM, Grönhagen–Riska C, Ekstrand AV. Glucose-Free Dialysis Solutions: Inductors of Inflammation or Preservers of Peritoneal Membrane? Perit Dial Int 2020. [DOI: 10.1177/089686080502500509] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives Glucose and other bioincompatible factors of conventional peritoneal dialysis solutions may damage the peritoneal membrane. The aim of our study was to investigate whether replacement of glucose with icodextrin (ID) or amino acids (AA) affects inflammatory parameters or cancer antigen 125 (CA125). Design Either ID or AA was used, in random order, in one daily exchange during an 8-week period. After the first study period, the patients entered a washout period and then switched to the other study solution for an 8-week period. C-reactive protein (CRP) was measured in serum, and CA125, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), and hyaluronan (HA) were measured in the overnight dwell dialysates at the beginning and end of the study periods. Setting A university hospital. Patients 22 patients with duration on peritoneal dialysis of 1.5 – 6.3 months. Main Outcome Measures Levels of serum CRP and dialysate CA125, IL-6, HA, and sICAM-1 during use of ID and AA were compared to levels during use of glucose-only-based solutions. Results CRP increased significantly during use of ID. CA125 increased significantly during 8 weeks’ use of AA, from 22.8 (5.4 – 89.0) to 42.9 (7.1 – 92.9) kU/L ( p = 0.007). IL-6 increased during 8 weeks’ use of AA, from 22.0 (9.0 – 108.0) to 36.5 (14.0 – 93.0) ng/L ( p = 0.002) and ID, from 25.5 (8.0 – 82.0) to 40.0 (12.0 – 118.0) ng/L ( p = 0.008). TNF-α also increased significantly during use of ID, but showed no significant changes during use of AA. Conclusions The use of glucose-free solutions, especially AA, may lead to preservation of mesothelial cell mass and host defense. However, activation of systemic and peritoneal inflammation may appear during the use of ID and to a lesser extent during use of AA.
Collapse
Affiliation(s)
- Terhi A. Martikainen
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Anna-Maija Teppo
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Carola Grönhagen–Riska
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Agneta V. Ekstrand
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
12
|
Abstract
The peritoneal mesothelium is composed of an extensive monolayer of mesothelial cells that lines the body's serous cavity and internal organs and was previously thought to act principally as a protective nonadhesive lubricating surface to facilitate intracoelomic movement. With the introduction of peritoneal dialysis over three decades ago, there has been much interest in the cell biology of peritoneal mesothelial cells. Independent studies have highlighted specific properties of the peritoneal mesothelial cell, including antigen presentation, regenerative properties, clearance of fibrin; synthesis of cytokines, growth factors, and matrix proteins; and secretion of lubricants to protect the tissue from abrasion, adhesion, infection, and tumor dissemination. It is now evident that the mesothelium is not merely a passive membrane but, rather, a dynamic membrane that contributes substantially to the structural, functional, and homeostatic properties of the peritoneum. Since peritoneal mesothelial cells in culture possess immunohistochemical markers identical to mesothelial stem cells, the culture of mesothelial cells offers researchers an essential tool to assess their morphologic, structural, and functional properties. This review will discuss current procedures to isolate peritoneal mesothelial cells from human omental specimens, animal sources, and spent dialysate. Furthermore, the functional and morphologic properties of mesothelial cells are discussed, together with the potential use of mesothelial cell culture in research and clinical applications.
Collapse
Affiliation(s)
- Susan Yung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Fu Keung Li
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tak Mao Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| |
Collapse
|
13
|
Cnossen TT, Gladziwa U, Van De Kerkhof JJ, Schalkwijk CG, Scheijen J, Van Amersfoort J, Moret K, Beerenhout CH, Kooman JP. The Influence of Bicarbonate/Lactate-Buffered PD Fluids on Nε-(Carboxyethyl)Lysine and Nε-(Carboxymethyl)Lysine in Peritoneal Effluent. Perit Dial Int 2020; 31:189-93. [DOI: 10.3747/pdi.2010.00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveAccumulation of advanced glycation end products (AGEs) may be involved in the pathogenesis of peritoneal membrane dysfunction. As glycoxidation may play an important role in AGE formation, peritoneal dialysis fluids with low levels of glucose degradation products (GDPs) might result in a reduction in AGE concentration in the peritoneal effluent. The aim of this study was to compare the effects of conventional glucose-containing dialysis solutions and low GDP level fluids on the concentration of the AGEs Nε-(carboxymethyl)lysine (CML) and Nε-(carboxyethyl)lysine (CEL) in peritoneal effluent.DesignProspective randomized control study.Methods23 patients were treated with either conventional glucose-containing fluid ( n = 11, group A) or low level GDP fluid ( n = 12, group B) during a period of 12 weeks. Before and after this period, CML and CEL were measured in peritoneal effluent.ResultsIn groups A and B there were changes in CML concentrations [respectively 13.7 ± 17.0 and -16.0 ± 46.0 nmol/L (NS)] and CEL concentrations (respectively 20.3 ± 26.6 and -8.8 ± 18.9 nmol/L, p = 0.015). Residual renal function (RRF) in groups A and B was, respectively, 6.8 and 6.1 mL/min (NS). CML, but not CEL, in the peritoneal effluent was inversely related to RRF ( r = -0.67, p < 0.05).ConclusionCEL, but not CML, in the peritoneal effluent appears to be influenced by the prescription of low GDP level fluid, probably due to the highly reduced concentration of methylglyoxal, which is needed for formation of CEL. CML is primarily influenced by RRF.
Collapse
Affiliation(s)
- Trijntje T. Cnossen
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), The Netherlands
| | - Ulrich Gladziwa
- Department of Internal Medicine, University of Witten/Herdecke
- Kuratorium für Heimdialyse, Würselen, Germany
| | - Jos J. Van De Kerkhof
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), The Netherlands
| | | | - Jean Scheijen
- Division of General Internal Medicine, Department of Internal Medicine, MUMC
| | | | - Karin Moret
- Department of Internal Medicine, Maxima Medical Centre, Veldhoven, The Netherlands
| | | | - Jeroen P. Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), The Netherlands
| |
Collapse
|
14
|
Abstract
Peritoneal sclerosis is an almost invariable consequence of peritoneal dialysis. In most circumstances it is “simple” sclerosis, manifesting clinically with an increasing peritoneal transport rate and loss of ultrafiltration capacity. In contrast, encapsulating peritoneal sclerosis is a life threatening and usually irreversible condition, associated with bowel obstruction, malnutrition and death. It is unknown whether common etiological factors underlie the development of these 2 clinically and pathologically distinct forms of peritoneal sclerosis. The majority of studies to date have investigated factors that contribute to “simple” sclerosis, although it remains possible that similar mechanisms are amplified in patients who develop encapsulated peritoneal sclerosis. The cellular elements that promote peritoneal sclerosis include the mesothelial cells, peritoneal fibroblasts and inflammatory cells. Factors that stimulate these cells to promote peritoneal fibrosis and neoangiogenesis, both inherent in the development of peritoneal sclerosis, include cytokines that are induced by exposure of the peritoneal membrane to high concentrations of glucose, advanced glycation of the peritoneal membrane and oxidative stress. The cumulative exposure to bioincompatible dialysate is likely to have an etiological role as the duration of dialysis correlates with the likelihood of developing peritoneal sclerosis. Indeed peritoneal dialysis using more biocompatible fluids has been shown to reduce the development of peritoneal sclerosis. The individual contribution of the factors implicated in the development of peritoneal sclerosis will only be determined by large scale peritoneal biopsy registries, which will be able to prospectively incorporate clinical and histological data and support clinical decision making.
Collapse
Affiliation(s)
- C Pollock
- Royal North Shore Hospital, University of Sydney, St Leonards, NSW 2065 Australia.
| |
Collapse
|
15
|
Yao Q, Qian JQ, Lin XH, Lindholm B. Inhibition of the Effect of High Glucose on the Expression of Smad in Human Peritoneal Mesothelial Cells. Int J Artif Organs 2018; 27:828-34. [PMID: 15560676 DOI: 10.1177/039139880402701003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective As high glucose (HG) concentration in peritoneal dialysis (PD) solution is thought to contribute to peritoneal fibrosis, and angiotensin II receptor blockers (ARBs) may have a key role in preventing fibrosis as they may inhibit the TGF- ß1–Smad pathway, the aims of this in vitro study were to investigate 1) if HG affects the expression of Smad in human peritoneal mesothelial cells (HPMCs) and 2) if ARB (losartan) can inhibit this effect. Methods HPMCs, obtained from non-renal patients undergoing elective abdominal surgery, were stimulated by HG solutions with different concentrations (1.5%, 2.5%, 4.25%) of dextrose and mannitol, and by solutions containing combination with dextrose and losartan. The supernatant was assayed for TGF- ß1 by ELISA and cells were collected for the analysis of Smad family by RT-PCR and Western Blot. Results 1) HG up-regulated the expression of Smad2 on both gene and protein levels, especially in 2.5% and 4.25% dextrose groups (P&0.05), and also stimulated the expression of Smad4 in 4.25% dextrose group. However, the expression of Smad3 was not affected. 2) High osmolality as such (using mannitol) did not affect the TGF-ß1-Smad signaling pathway. 3) Losartan inhibited the expression of Smad2 on the gene level but not on the protein level. 4) HG up-regulated the level of TGF- ß1 with increasing dextrose concentration, while losartan partially inhibited this effect of HG on releasing of TGF-ß1. Conclusion A high glucose solution up-regulated the expression of Smad2 and Smad4, suggesting that the TGF- ß1-Smad pathway could be involved in the fibrosis of the peritoneum during PD. As losartan inhibited the expression of Smad2 on the gene level and reduced the concentration of TGF- ß1 in our study, the results of this in vitro study suggest that the use of angiotensin II receptor blockers might represent a possible way to prevent and treat peritoneal fibrosis in PD patients. However, further studies in vivo are needed to confirm this hypothesis.
Collapse
Affiliation(s)
- Q Yao
- Department of Clinical Science, Karolinska Institutet, Stockholm - Sweden
| | | | | | | |
Collapse
|
16
|
Abstract
The term peritoneal sclerosis can be applied to a vast range of peritoneal alterations. At one end of the range we have the slight peritoneal sclerosis constantly associated with peritoneal dialysis, which may be defined as simple sclerosis. Its clinical impact is slight. The role of glucose in determining peritoneal sclerosis is supported by morphological studies and therefore backed by much biochemical and immunological data.
Collapse
|
17
|
Al-Hwiesh AK, Shawarby MA, Abdul-Rahman IS, Al-Oudah N, Al-Dhofairy B, Divino-Filho JC, Abdelrahman A, Zakaria H, Nasr El-Din MA, Eldamati A, El-Salamony T, Al-Muhanna FA. Changes in peritoneal membrane with different peritoneal dialysis solutions: Is there a difference? Int J Organ Transplant Med 2016. [DOI: 10.1016/j.hkjn.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
18
|
Yung S, Lui SL, Ng CKF, Yim A, Ma MKM, Lo KY, Chow CC, Chu KH, Chak WL, Lam MF, Yung CY, Yip TPS, Wong S, Tang CSO, Ng FSK, Chan TM. Impact of a low-glucose peritoneal dialysis regimen on fibrosis and inflammation biomarkers. Perit Dial Int 2016; 35:147-58. [PMID: 25904773 DOI: 10.3747/pdi.2014.00125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impact of a low-glucose peritoneal dialysis (PD) regimen on biomarkers of peritoneal inflammation, fibrosis and membrane integrity remains to be investigated. METHODS In a randomized, prospective study, 80 incident PD patients received either a low-glucose regimen comprising Physioneal (P), Extraneal (E) and Nutrineal (N) (Baxter Healthcare Corporation, Deerfield, IL, USA) (PEN group), or Dianeal (control group) for 12 months, after which both groups continued with Dianeal dialysis for 6 months. Serum and dialysate levels of vascular endothelial growth factor (VEGF), decorin, hepatocyte growth factor (HGF), interleukin-6 (IL-6), macrophage migration inhibitory factor (MIF), hyaluronan (HA), adiponectin, soluble-intracellular adhesion molecule (s-ICAM), vascular cell adhesion molecule-1 (VCAM-1) and P-selectin, and dialysate cancer antigen 125 (CA125), were measured after 12 and 18 months. This paper focuses on results after 12 months, when patients in the PEN group changed to glucose-based PD fluid (PDF). RESULTS At the end of 12 months, effluent dialysate levels of CA125, decorin, HGF, IL-6, adiponectin and adhesion molecules were significantly higher in the PEN group compared to controls, but all decreased after patients switched to glucose-based PDF. Macrophage migration inhibitory factor level was lower in the PEN group but increased after changing to glucose-based PDF and was similar to controls at 18 months. Serum adiponectin level was higher in the PEN group at 12 months, but was similar in the 2 groups at 18 months. Body weight, residual renal function, ultrafiltration volume and total Kt/V did not differ between both groups. Dialysate-to-plasma creatinine ratio at 4 h was higher in the PEN group at 12 months and remained so after switching to glucose-based PDF. CONCLUSION Changes in the biomarkers suggest that the PEN PD regimen may be associated with better preservation of peritoneal membrane integrity and reduced systemic vascular endothelial injury.
Collapse
Affiliation(s)
- Susan Yung
- Department of Medicine, University of Hong Kong, Hong Kong
| | | | - Chris K F Ng
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Andrew Yim
- Department of Medicine, University of Hong Kong, Hong Kong
| | | | | | | | | | | | | | | | | | | | - Colin S O Tang
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Flora S K Ng
- Department of Medicine, University of Hong Kong, Hong Kong Tung Wah Hospital, Hong Kong
| | - Tak Mao Chan
- Department of Medicine, University of Hong Kong, Hong Kong Queen Mary Hospital, Hong Kong
| |
Collapse
|
19
|
Coester AM, Zweers MM, de Waart DR, Krediet RT. The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients. NDT Plus 2015; 1:iv41-iv45. [PMID: 25983985 PMCID: PMC4421150 DOI: 10.1093/ndtplus/sfn123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 06/19/2008] [Indexed: 11/16/2022] Open
Abstract
Background. Recently, we found evidence of effluent potassium (K+) additional to diffusion and convection, suggesting cellular release (CR). Its relationship with free water transport (FWT) in stable peritoneal dialysis (PD) patients suggested an effect of hypertonicity of the dialysis solution leading to cell shrinkage. The aim of the present study was to reproduce these findings in groups according to PD duration and to further investigate the role of mesothelial cells in the observed phenomenon. Methods. Standard peritoneal permeability analyses done with 3.86% glucose were analysed cross-sectionally in three different groups: short-term (n = 53) 0–2 years PD treatment; medium-term (n = 24) 2–4 years PD and long-term (n = 26) > 4 years PD. Results. The time courses for FWT and cellular release of K+ (CR-K+) during the dwell were not significantly different among the groups. Cancer antigen (CA) 125 was highest in the short-term group (P ≤ 0.02) and had a strong positive correlation with mass transfer area coefficient of creatinine (MTAC-creatinine) only in the short-term group (r = 0.62, P ≤ 0.01). CA125 had no relationship with either CR-K+ or FWT, except for negative relationships in the short-term group (CR-K+, r = −0.41, P ≤ 0.05; FWT, r = −0.54, P ≤ 0.05). Conclusion. We conclude that the correlation of CA125 and MTAC-creatinine is dependent on PD duration and underlines the in vitro observation that mesothelial cells produce vasoactive substances that may increase the peritoneal surface area. However, CA125 is not directly related to CR-K+ or FWT. Therefore, the relationship between FWT and CR-K+ is likely to reflect hypertonic cell shrinkage, regardless of the duration of PD, and confirms our earlier findings.
Collapse
Affiliation(s)
| | | | - Dirk R de Waart
- Department of Experimental Hepatology, Academic Medical Centre , University of Amsterdam , The Netherlands
| | | |
Collapse
|
20
|
Stojimirović B, Jovanović N, Trbojević-Stanković J, Nešić DM, Brašanac T, Žunić-Božinovski S. Levels of transforming growth factorβ1 during first six months of peritoneal dialysis. Ren Fail 2015; 37:640-5. [DOI: 10.3109/0886022x.2015.1010417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Farhat K, Stavenuiter AWD, Beelen RHJ, Ter Wee PM. Pharmacologic targets and peritoneal membrane remodeling. Perit Dial Int 2014; 34:114-23. [PMID: 24525599 DOI: 10.3747/pdi.2011.00332] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Peritoneal dialysis (PD) is associated with functional and structural changes of the peritoneal membrane, also known as peritoneal remodeling. The peritoneal membrane is affected by many endogenous and exogenous factors such as cytokines, PD fluids, and therapeutic interventions. Here, we present an overview of various studies that have investigated pharmacologic interventions aimed at regression of peritoneal damage and prolongation of PD treatment.
Collapse
Affiliation(s)
- Karima Farhat
- Department of Nephrology,1 VU University Medical Center, and Department of Molecular Cell Biology and Immunology,2 VU University, Amsterdam, Netherlands
| | | | | | | |
Collapse
|
22
|
Büchel J, Bartosova M, Eich G, Wittenberger T, Klein-Hitpass L, Steppan S, Hackert T, Schaefer F, Passlick-Deetjen J, Schmitt CP. Interference of peritoneal dialysis fluids with cell cycle mechanisms. Perit Dial Int 2014; 35:259-74. [PMID: 25082841 DOI: 10.3747/pdi.2013.00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/28/2014] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Peritoneal dialysis fluids (PDF) differ with respect to osmotic and buffer compound, and pH and glucose degradation products (GDP) content. The impact on peritoneal membrane integrity is still insufficiently described. We assessed global genomic effects of PDF in primary human peritoneal mesothelial cells (PMC) by whole genome analyses, quantitative real-time polymerase chain reaction (RT-PCR) and functional measurements. METHODS PMC isolated from omentum of non-uremic patients were incubated with conventional single chamber PDF (CPDF), lactate- (LPDF), bicarbonate- (BPDF) and bicarbonate/lactate-buffered double-chamber PDF (BLPDF), icodextrin (IPDF) and amino acid PDF (APDF), diluted 1:1 with medium. Affymetrix GeneChip U133Plus2.0 (Affymetrix, CA, USA) and quantitative RT-PCR were applied; cell viability was assessed by proliferation assays. RESULTS The number of differentially expressed genes compared to medium was 464 with APDF, 208 with CPDF, 169 with IPDF, 71 with LPDF, 45 with BPDF and 42 with BLPDF. Out of these genes 74%, 73%, 79%, 72%, 47% and 57% were downregulated. Gene Ontology (GO) term annotations mainly revealed associations with cell cycle (p = 10(-35)), cell division, mitosis, and DNA replication. One hundred and eighteen out of 249 probe sets detecting genes involved in cell cycle/division were suppressed, with APDF-treated PMC being affected the most regarding absolute number and degree, followed by CPDF and IPDF. Bicarbonate-containing PDF and BLPDF-treated PMC were affected the least. Quantitative RT-PCR measurements confirmed microarray findings for key cell cycle genes (CDK1/CCNB1/CCNE2/AURKA/KIF11/KIF14). Suppression was lowest for BPDF and BLPDF, they upregulated CCNE2 and SMC4. All PDF upregulated 3 out of 4 assessed cell cycle repressors (p53/BAX/p21). Cell viability scores confirmed gene expression results, being 79% of medium for LPDF, 101% for BLPDF, 51% for CPDF and 23% for IPDF. Amino acid-containing PDF (84%) incubated cells were as viable as BPDF (86%). CONCLUSION In conclusion, PD solutions substantially differ with regard to their gene regulating profile and impact on vital functions of PMC, i.e. on cells known to be essential for peritoneal membrane homeostasis.
Collapse
Affiliation(s)
- Janine Büchel
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Maria Bartosova
- University Hospital for Pediatrics & Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gwendolyn Eich
- University Hospital for Pediatrics & Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Ludger Klein-Hitpass
- University of Duisburg-Essen, Faculty of Medicine, Institute of Cell Biology, Essen, Germany
| | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Franz Schaefer
- University Hospital for Pediatrics & Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Claus P Schmitt
- University Hospital for Pediatrics & Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
23
|
Mesenchymal Conversion of Mesothelial Cells Is a Key Event in the Pathophysiology of the Peritoneum during Peritoneal Dialysis. Adv Med 2014; 2014:473134. [PMID: 26556413 PMCID: PMC4590954 DOI: 10.1155/2014/473134] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/09/2013] [Accepted: 11/18/2013] [Indexed: 12/03/2022] Open
Abstract
Peritoneal dialysis (PD) is a therapeutic option for the treatment of end-stage renal disease and is based on the use of the peritoneum as a semipermeable membrane for the exchange of toxic solutes and water. Long-term exposure of the peritoneal membrane to hyperosmotic PD fluids causes inflammation, loss of the mesothelial cells monolayer, fibrosis, vasculopathy, and angiogenesis, which may lead to peritoneal functional decline. Peritonitis may further exacerbate the injury of the peritoneal membrane. In parallel with these peritoneal alterations, mesothelial cells undergo an epithelial to mesenchymal transition (EMT), which has been associated with peritoneal deterioration. Factors contributing to the bioincompatibility of classical PD fluids include the high content of glucose/glucose degradation products (GDPs) and their acidic pH. New generation low-GDPs-neutral pH fluids have improved biocompatibility resulting in better preservation of the peritoneum. However, standard glucose-based fluids are still needed, as biocompatible solutions are expensive for many potential users. An alternative approach to preserve the peritoneal membrane, complementary to the efforts to improve fluid biocompatibility, is the use of pharmacological agents protecting the mesothelium. This paper provides a comprehensive review of recent advances that point to the EMT of mesothelial cells as a potential therapeutic target to preserve membrane function.
Collapse
|
24
|
Peritoneal fibrosis and the putative role of decorin. Int J Organ Transplant Med 2013. [DOI: 10.1016/j.hkjn.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
25
|
Wang J, Jiang ZP, Su N, Fan JJ, Ruan YP, Peng WX, Li YF, Yu XQ. The role of peritoneal alternatively activated macrophages in the process of peritoneal fibrosis related to peritoneal dialysis. Int J Mol Sci 2013; 14:10369-82. [PMID: 23685870 PMCID: PMC3676844 DOI: 10.3390/ijms140510369] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022] Open
Abstract
It has been confirmed that alternatively activated macrophages (M2) participate in tissue remodeling and fibrosis occurrence, but the effect of M2 on peritoneal fibrosis related to peritoneal dialysis (PD) hasn’t been elucidated. This study was therefore conducted to assess the association between M2 and peritoneal fibrosis related to PD. In this study, peritoneal fibrosis was induced by intraperitoneal (i.p.) injection of Lactate-4.25% dialysate (100 mL/kg) to C57BL/6J mice for 28 days, and liposome-encapsulated clodronate (LC, the specific scavenger of macrophages) was used to treat the peritoneal fibrosis mice model by i.p. injection at day 18 and day 21. All animals were sacrificed at day 29. Parietal peritonea were stained with Masson’s trichrome, and the expression of type I collagen (Col-I), fibronectin, mannose receptor (CD206), transforming growth factor beta (TGF-β), chemokine receptor 7 (CCR7), chitinase 3-like 3 (Ym-1) and arginase-1 (Arg-1) was determined by Western blotting, immunofluorescence and quantitative real-time PCR. Our results revealed that peritoneal thickness, Col-I, fibronectin, CD206, TGF-β, Ym-1 and Arg-1 were upregulated in the peritoneal fibrosis mice model, and all of these indexes were downregulated in those treated with LC. Additionally, there was no difference in the level of CCR7 between the model and treatment group. Our study indicated that peritoneal M2 played an important role in the process of peritoneal fibrosis related to PD and might be a potential target for intervention therapy of peritoneal fibrosis.
Collapse
Affiliation(s)
- Jie Wang
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
| | - Zong-Pei Jiang
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
- Department of Nephrology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Ning Su
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
| | - Jin-Jin Fan
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
| | - Yi-Ping Ruan
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
| | - Wen-Xing Peng
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
| | - Ya-Fang Li
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
| | - Xue-Qing Yu
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Nephrology, Ministry of Health, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; E-Mails: (J.W.); (Z.-P.J.); (N.S.); (J.-J.F.); (Y.-P.R.); (W.-X.P.); (Y.-F.L.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +86-20-8776-6335; Fax: +86-20-8776-9673
| |
Collapse
|
26
|
Pérez-Lozano ML, Sandoval P, Rynne-Vidal Á, Aguilera A, Jiménez-Heffernan JA, Albar-Vizcaíno P, Majano PL, Sánchez-Tomero JA, Selgas R, López-Cabrera M. Functional relevance of the switch of VEGF receptors/co-receptors during peritoneal dialysis-induced mesothelial to mesenchymal transition. PLoS One 2013; 8:e60776. [PMID: 23585849 PMCID: PMC3621952 DOI: 10.1371/journal.pone.0060776] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/02/2013] [Indexed: 12/17/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is up-regulated during mesothelial to mesenchymal transition (MMT) and has been associated with peritoneal membrane dysfunction in peritoneal dialysis (PD) patients. It has been shown that normal and malignant mesothelial cells (MCs) express VEGF receptors (VEGFRs) and co-receptors and that VEGF is an autocrine growth factor for mesothelioma. Hence, we evaluated the expression patterns and the functional relevance of the VEGF/VEGFRs/co-receptors axis during the mesenchymal conversion of MCs induced by peritoneal dialysis. Omentum-derived MCs treated with TGF-β1 plus IL-1β (in vitro MMT) and PD effluent-derived MCs with non-epithelioid phenotype (ex vivo MMT) showed down-regulated expression of the two main receptors Flt-1/VEGFR-1 and KDR/VEGFR-2, whereas the co-receptor neuropilin-1 (Nrp-1) was up-regulated. The expression of the Nrp-1 ligand semaphorin-3A (Sema-3A), a functional VEGF competitor, was repressed throughout the MMT process. These expression pattern changes were accompanied by a reduction of the proliferation capacity and by a parallel induction of the invasive capacity of MCs that had undergone an in vitro or ex vivo MMT. Treatment with neutralizing anti-VEGF or anti-Nrp-1 antibodies showed that these molecules played a relevant role in cellular proliferation only in naïve omentum-derived MCs. Conversely, treatment with these blocking antibodies, as well as with recombinant Sema-3A, indicated that the switched VEGF/VEGFRs/co-receptors axis drove the enhanced invasion capacity of MCs undergoing MMT. In conclusion, the expression patterns of VEGFRs and co-receptors change in MCs during MMT, which in turn would determine their behaviour in terms of proliferation and invasion in response to VEGF.
Collapse
Affiliation(s)
| | - Pilar Sandoval
- Centro de Biología Molecular-Severo Ochoa, CSIC-UAM, Cantoblanco, Madrid, Spain
| | - Ángela Rynne-Vidal
- Centro de Biología Molecular-Severo Ochoa, CSIC-UAM, Cantoblanco, Madrid, Spain
| | - Abelardo Aguilera
- Unidad de Biología Molecular and Servicio de Nefrología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - José Antonio Jiménez-Heffernan
- Servicio de Anatomía Patológica, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Patricia Albar-Vizcaíno
- Unidad de Biología Molecular and Servicio de Nefrología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Pedro L. Majano
- Unidad de Biología Molecular and Servicio de Nefrología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - José Antonio Sánchez-Tomero
- Unidad de Biología Molecular and Servicio de Nefrología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Rafael Selgas
- Servicio de Nefrología. Hospital Universitario La Paz, Instituto de Investigación Sanitaria la Paz (IdiPAZ), Madrid, Spain
| | - Manuel López-Cabrera
- Centro de Biología Molecular-Severo Ochoa, CSIC-UAM, Cantoblanco, Madrid, Spain
- * E-mail:
| |
Collapse
|
27
|
Matsumoto M, Tamura M, Miyamoto T, Furuno Y, Kabashima N, Serino R, Shibata T, Kanegae K, Takeuchi M, Abe H, Okazaki M, Otsuji Y. Impacts of icodextrin on integrin-mediated wound healing of peritoneal mesothelial cells. Life Sci 2012; 90:917-23. [DOI: 10.1016/j.lfs.2012.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/28/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
|
28
|
Yaginuma T, Yamamoto I, Yamamoto H, Mitome J, Tanno Y, Yokoyama K, Hayashi T, Kobayashi T, Watanabe M, Yamaguchi Y, Hosoya T. Increased lymphatic vessels in patients with encapsulating peritoneal sclerosis. Perit Dial Int 2012; 32:617-27. [PMID: 22661673 DOI: 10.3747/pdi.2011.00096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The angiogenic response is partly involved in the progression of encapsulating peritoneal sclerosis (EPS). However, the details of the angiogenic response, especially for lymphatic vessels in patients with EPS, remain unclear. In addition, because of technical limitations, morphology studies reported to date have examined only the parietal peritoneum. The morphologies of parietal and visceral lymphatic vessels in patients with EPS both need to be analyzed. METHODS We examined peritoneal samples from 18 patients with EPS who underwent enterolysis of the visceral peritoneum and compared them with samples from 17 autopsy cases (controls). To examine the angiogenic response, we performed immunohistochemistry for the endothelial markers CD34 (blood vessels) and podoplanin (lymphatic vessels) and for the cell proliferation marker Ki-67. Immunogold electron microscopy analysis for podoplanin was also performed. In 7 of 18 cases, we compared differences in the angiogenic response of the parietal and visceral peritoneal membranes. RESULTS Angiogenic responses were more frequent in the compact zone than in regenerated layers. The number of capillaries positive for anti-CD34 and anti-podoplanin monoclonal antibodies per unit area of visceral peritoneal tissue was, respectively, 41.1 ± 29.3/mm(2) in EPS patients and 2.7 ± 4.4/mm(2) in controls (p ≤ 0.01) and 48.1 ± 43.9/mm(2) in EPS patients and 4.1 ± 5.4/mm(2) in controls (p ≤ 0.01). The percentage of capillaries positive for anti-Ki-67, CD34, and podoplanin was 4.6% in EPS patients (p ≤ 0.01) and 0.8% in controls (p = 0.09). The immunogold electron microscopy analysis revealed that podoplanin was localized to endothelial cells with anchoring filaments, a specific feature of lymphatic vessels. Furthermore, compared with parietal peritoneal membrane, visceral peritoneal membrane had a more prominent podoplanin-positive capillary profile, but not a prominent CD34-positive capillary profile. In addition, fibroblast-like cells double-positive for podoplanin and smooth muscle actin were markedly increased in the degenerated layer, as previously reported. CONCLUSIONS Our study demonstrated that lymphatic vessels are increased in the visceral peritoneum of patients with EPS.
Collapse
Affiliation(s)
- Tatsuhiro Yaginuma
- Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Mikuła-Pietrasik J, Kuczmarska A, Kucińska M, Murias M, Wierzchowski M, Winckiewicz M, Staniszewski R, Bręborowicz A, Książek K. Resveratrol and its synthetic derivatives exert opposite effects on mesothelial cell-dependent angiogenesis via modulating secretion of VEGF and IL-8/CXCL8. Angiogenesis 2012; 15:361-76. [PMID: 22451299 PMCID: PMC3409370 DOI: 10.1007/s10456-012-9266-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 03/13/2012] [Indexed: 11/19/2022]
Abstract
We examined the effect of resveratrol (RVT) and its two derivatives (3,3′,4,4′-tetrahydroxy-trans-stilbene and 3,3′,4,4′,5,5′-hexahydroxy-trans-stilbene) on human peritoneal mesothelial cell (HPMC)-dependent angiogenesis in vitro. To this end, angiogenic activity of endothelial cells (HUVEC, HMVEC, and HMEC-1) was monitored upon their exposure to conditioned medium (CM) from young and senescent HPMCs treated with stilbenes or to stilbenes themselves. Results showed that proliferation and migration of endothelial cells were inhibited in response to indirect (HPMC-dependent) or direct RVT activity. This effect was associated with decreased secretion of VEGF and IL-8/CXCL8 by HPMCs treated with RVT, which confirmed the experiments with recombinant forms of these angiogenic agents. Angiogenic activity of endothelial cells treated with CM from HPMCs exposed to RVT analogues was more effective. Improved migration was particularly evident in cells exposed to CM from senescent HPMCs. Upon direct treatment, RVT derivatives stimulated proliferation (but not migration) of HUVECs, and failed to affect the behaviour of HMVEC and HMEC-1 cells. These compounds stimulated production of VEGF and IL-8/CXCL8 by HPMCs. Studies with neutralizing antibodies against angiogenic factors revealed that augmented angiogenic reactions of endothelial cells exposed to CM from HPMC treated with RVT analogues were related to enhanced production of VEGF and IL-8/CXCL8. Collectively, these findings indicate that RVT and its synthetic analogues divergently alter the secretion of the angiogenic factors by HPMCs, and thus modulate HPMC-dependent angiogenic responses in the opposite directions. This may have implications for the attempts of practical employment of the stilbenes for treatment of pathologies proceeding with abnormal vascularisation of the peritoneal tissue.
Collapse
Affiliation(s)
- Justyna Mikuła-Pietrasik
- Department of Pathophysiology, Poznań University of Medical Sciences, Święcickiego 6 Str., 60-781, Poznań, Poland
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Pathophysiology of the peritoneal membrane during peritoneal dialysis: the role of hyaluronan. J Biomed Biotechnol 2011; 2011:180594. [PMID: 22203782 PMCID: PMC3238805 DOI: 10.1155/2011/180594] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/11/2011] [Accepted: 09/12/2011] [Indexed: 01/28/2023] Open
Abstract
During peritoneal dialysis (PD), constant exposure of mesothelial cells to bioincompatible PD solutions results in the denudation of the mesothelial monolayer and impairment of mesothelial cell function. Hyaluronan, a major component of extracellular matrices, is synthesized by mesothelial cells and contributes to remesothelialization, maintenance of cell phenotype, and tissue remodeling and provides structural support to the peritoneal membrane. Chronic peritoneal inflammation is observed in long-term PD patients and is associated with increased hyaluronan synthesis. During inflammation, depolymerization of hyaluronan may occur with the generation of hyaluronan fragments. In contrast to native hyaluronan which offers a protective role to the peritoneum, hyaluronan fragments exacerbate inflammatory and fibrotic processes and therefore assist in the destruction of the tissue. This paper will discuss the contribution of mesothelial cells to peritoneal membrane alterations that are induced by PD and the putative role of hyaluronan in these processes.
Collapse
|
31
|
Korte MR, Sampimon DE, Betjes MGH, Krediet RT. Encapsulating peritoneal sclerosis: the state of affairs. Nat Rev Nephrol 2011; 7:528-38. [PMID: 21808281 DOI: 10.1038/nrneph.2011.93] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD) with a 50% mortality rate. EPS is characterized by progressive and excessive fibrotic thickening of the peritoneum, leading to encapsulation of the bowels and intestinal obstruction. At present, EPS cannot be detected with certainty during its early stages; however, a progressive loss of ultrafiltration capacity often precedes its development. Studies that attempted to elucidate the pathogenesis of EPS have shown that the duration of exposure to PD fluids is the most important risk factor for EPS, and that young age and possibly the effects of peritonitis are additional contributory factors. The pathophysiology of EPS is probably best described as a multiple-hit process with a central role for transforming growth factor β. A form of EPS that develops shortly after kidney transplantation has also been recognized as a distinct clinical entity, and may be a common form of EPS in countries with a high transplantation rate. Criteria have been developed to identify EPS by abdominal CT scan at the symptomatic stage, but further clinical research is needed to identify early EPS in asymptomatic patients, to clarify additional risk factors for EPS and to define optimal treatment strategies.
Collapse
Affiliation(s)
- Mario R Korte
- Albert Schweitzer Hospital, Department of Internal Medicine, PO Box 444, 3300 AK Dordrecht, The Netherlands.
| | | | | | | |
Collapse
|
32
|
Chunming J, Miao Z, Cheng S, Nana T, Wei Z, Dongwei C, Yuan F. Tanshinone IIA attenuates peritoneal fibrosis through inhibition of fibrogenic growth factors expression in peritoneum in a peritoneal dialysis rat model. Ren Fail 2011; 33:355-62. [PMID: 21401363 DOI: 10.3109/0886022x.2011.559681] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peritoneal fibrosis is a common complication of long-term peritoneal dialysis (PD) and is the main cause of dialysis inadequacy and PD withdrawal. It has been reported that Tanshinone IIA can ameliorate fibrosis in various tissues. In this report, we investigate the effects of Tanshinone IIA on peritoneal fibrosis in an animal model. METHODS Forty rats were randomly divided into four groups (n = 10 per group) that received daily intraperitoneal injection of saline, 4.25% glucose-based peritoneal dialysis fluid (PDF), or PDF along with 50 or 100 mg/L Tanshinone IIA. Eight weeks later, the rats were sacrificed and peritoneal tissue samples were collected for analysis. The expression of transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF) in parietal peritoneum was examined by immunohistochemistry. The mRNA and protein expression of TGF-β1 and CTGF in omentum was examined by reverse transcription polymerase chain reaction or Western blot. RESULTS Tanshinone IIA significantly suppressed submesothelial compact zone thickening and matrix accumulation induced by 4.25% glucose-based PDF. Tanshinone IIA also reduced TGF-β1 and CTGF expression in parietal peritoneum as well as in omentum in a dose-dependent manner. CONCLUSION Tanshinone IIA prevented the progression of peritoneal fibrosis in this rat model. Tanshinone IIA may be a novel therapy for peritoneal fibrosis in patients undergoing long-term PD.
Collapse
Affiliation(s)
- Jiang Chunming
- Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, PR China
| | | | | | | | | | | | | |
Collapse
|
33
|
Xie JY, Chen N, Ren H, Wang WM. Angiotensin II-mediated activation of fibrotic pathways through ERK1/2 in rat peritoneal mesothelial cells. Ren Fail 2010; 32:871-9. [DOI: 10.3109/0886022x.2010.494807] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
The renin-angiotensin-aldosterone system in peritoneal dialysis: is what is good for the kidney also good for the peritoneum? Kidney Int 2010; 78:23-8. [PMID: 20336052 DOI: 10.1038/ki.2010.90] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Morphological changes of the peritoneal membrane that occur over time among patients on peritoneal dialysis include fibrosis and neoangiogenesis. While the pathophysiologic mechanisms underlying these changes are not fully understood, the activation of the renin-angiotensin-aldosterone system (RAAS) may have an important role. Components of the RAAS are constitutively expressed within peritoneal mesothelial cells, and are upregulated in the presence of acute inflammation and chronic exposure to peritoneal dialysate. The high glucose concentration, low pH, and the presence of glucose degradation products in peritoneal dialysis solutions have all been implicated in modulation of peritoneal RAAS. Furthermore, activation of the RAAS, as well as the downstream production of transforming growth factor-beta, contributes to epithelial-to-mesenchymal transformation of mesothelial cells, resulting in progressive fibrosis of the peritoneal membrane. This process also leads to increased vascular endothelial growth factor production, which promotes peritoneal neoangiogenesis. Functionally, these changes translate into reduced ultrafiltration capacity of the peritoneal membrane, which is an important cause of technique failure among patients on long-term peritoneal dialysis. This brief review will describe our current state of knowledge about the role of peritoneal RAAS in peritoneal membrane damage and potential strategies to protect the membrane.
Collapse
|
35
|
Nakao A, Nakao K, Takatori Y, Kojo S, Inoue J, Akagi S, Sugiyama H, Wada J, Makino H. Effects of icodextrin peritoneal dialysis solution on the peritoneal membrane in the STZ-induced diabetic rat model with partial nephrectomy. Nephrol Dial Transplant 2009; 25:1479-88. [DOI: 10.1093/ndt/gfp479] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Han SH, Ahn SV, Yun JY, Tranaeus A, Han DS. Mortality and technique failure in peritoneal dialysis patients using advanced peritoneal dialysis solutions. Am J Kidney Dis 2009; 54:711-20. [PMID: 19619922 DOI: 10.1053/j.ajkd.2009.05.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 05/20/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the theoretical benefits of biocompatible physiological-pH bicarbonate/lactate-buffered (B/L) peritoneal dialysis solution, there is only limited evidence supporting a superior clinical outcome associated with its use. STUDY DESIGN Observational study. SETTINGS & PARTICIPANTS 2,163 patients starting peritoneal dialysis therapy between July 2003 and December 2006 from 54 centers in Korea were enrolled. PREDICTORS B/L solution and icodextrin use. OUTCOMES All-cause mortality and technique failure. MEASUREMENTS Patient outcomes were compared between patients prescribed B/L and conventional solutions by using propensity score and intention-to-treat analyses. RESULTS 542 patients initiated peritoneal dialysis therapy with B/L solution, and 1,621, with conventional solution. Fifteen patients prescribed B/L solution switched to conventional solution, and 386 of those initially using conventional solution switched to B/L solution during follow-up. Propensity score matching yielded 542 matched pairs of patients. In the matched cohort, there were no significant differences in age, diabetes, cardiovascular comorbidity, socioeconomic status, icodextrin use, or center experience between the 2 groups. All-cause deaths occurred in 52 (9.6%) patients in the B/L-solution group compared with 102 (18.9%) in the conventional-solution group (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.50 to 0.98; P = 0.04). In addition, icodextrin use was significantly associated with a reduced risk of death (HR, 0.40; 95% CI, 0.28 to 0.58; P < 0.001). Thirty-three (6.1%) and 48 (8.9%) technique failures occurred in the B/L- and conventional-solution groups, respectively (HR, 0.91; 95% CI, 0.58 to 1.43; P = 0.7). The survival benefit of B/L solution persisted in the unmatched cohort (HR, 0.69; 95% CI, 0.52 to 0.93; P = 0.02). LIMITATIONS Retrospective analysis, lack of laboratory data, and unknown indications for use of B/L solution. CONCLUSION Use of a biocompatible B/L peritoneal dialysis solution with physiological pH is associated with improved survival compared with conventional solution. Large randomized clinical trials are warranted to confirm this finding.
Collapse
Affiliation(s)
- Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
37
|
Mondello S, Mazzon E, Di Paola R, Crisafulli C, Italiano D, Buemi M, Aloisi C, Cuzzocrea S. Erythropoietin suppresses peritoneal fibrosis in rat experimental model. Eur J Pharmacol 2009; 604:138-49. [DOI: 10.1016/j.ejphar.2008.11.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 11/04/2008] [Accepted: 11/20/2008] [Indexed: 12/15/2022]
|
38
|
Pawlaczyk K, Polubinska A, Numata N, Nakayama M, Pecoits-Filho R, Czekalski S, Lindholm B, Breborowicz A. Vascular endothelial growth factor in dialysate in relation to intensity of peritoneal inflammation. Int J Artif Organs 2008; 31:535-44. [PMID: 18609506 DOI: 10.1177/039139880803100609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Peritoneal inflammation may induce changes in peritoneal microvessels, including neoangiogenesis/vasculogenesis, leading to increased peritoneal solute transport rate (PSTR) and loss of ultrafiltration capacity. We hypothesized that an inflammatory reaction in the peritoneal cavity during peritonitis induces increased synthesis of vascular endothelial growth factor (VEGF). We therefore studied the relationship between peritoneal inflammation markers, VEGF, and transport of fluid and solutes in rats during acute peritoneal inflammation induced by lipopolysaccharide (LPS) added to standard glucose-based dialysis solution. METHODS Under ether anesthesia, male Wistar rats were injected intraperitoneally with 30 mL Dianeal 3.86% without (Control; n=6) or with LPS (microg/mL): 0.001 (LPS 0.001; n=6), 0.01 (LPS 0.01; n=7), 0.1 (LPS 0.1; n=7), 1.0 (LPS 1.0; n=8). After 8 hours, dialysate volume (IPV), peritoneal solute transport rate (PSTR) and dialysate cell count (DCC) were measured and effluent samples were collected. RESULTS LPS i.p. resulted in increased PSTR and decreased IPV (p<0.005). DCC (cells/microL) and the neutrophil/macrophage ratio were higher for all LPS concentrations compared to the control group. After 8 hours, LPS-exposed rats had significantly higher dialysate levels of all investigated cytokines (TNF-alfa, MCP-1 and IL-10) than the control group. Addition of LPS resulted in increased dialysate VEGF concentrations (pg/mL) (LPS 0.001, 28.2+/-5.9; LPS 0.01, 38.9+/-11.6; LPS 0.1, 43.0+/-5.9; LPS 1.0, 46.6+/-11.3; Control, 14.5+/-9.8; p<0.0005 for all LPS vs. Control). CONCLUSIONS The infusion of Dianeal 3.86% with different doses of LPS induced a strong acute intraperitoneal inflammatory reaction with increased DCC and cytokine levels, resulting in increased peritoneal solute transport and decreased IPV. LPS induced a dose-dependent parallel increase of the intraperitoneal concentrations of MCP-1, IL-10 and TNF-alfa, as well as of VEGF. These results suggest that intraperitoneal VEGF synthesis is induced in response to inflammation, and that this may be an important component in the process leading to peritoneal transport alterations.
Collapse
Affiliation(s)
- K Pawlaczyk
- Department of Pathophysiology and Nephrology, Poznan Medical School, Poznan - Poland
| | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Witowski J, Ksiazek K, Jörres A. Glucose-Induced Mesothelial Cell Senescence and Peritoneal Neoangiogenesis and Fibrosis. Perit Dial Int 2008. [DOI: 10.1177/089686080802805s07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Janusz Witowski
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- Department of Pathophysiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Krzysztof Ksiazek
- Department of Pathophysiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Achim Jörres
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| |
Collapse
|
41
|
Bozkurt D, Cetin P, Sipahi S, Hur E, Nar H, Ertilav M, Sezak M, Duman S. The Effects of Renin–angiotensin System Inhibition on Regression of Encapsulating Peritoneal Sclerosis. Perit Dial Int 2008. [DOI: 10.1177/089686080802805s08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with symptoms of ileus and irreversible sclerosis of both visceral and parietal peritoneum. Peritoneal dialysis (PD) patients rarely develop EPS, a severe life-threatening condition of unknown pathogenesis. Angiotensin II is known to promote fibrosis and inflammation in various tissues. Renin–angiotensin system (RAS) blockade provides advantages in the course of diseases such as hypertension, chronic kidney disease, and proteinuria. We have also previously shown that RAS blockade has beneficial effects on hypertonic (3.86%) PD solution-induced peritoneal alterations. Because it shares the same characteristics as other fibrotic processes, peritoneal fibrosis can benefit from RAS blockade. Objective To determine the advantages of RAS blockade in regression of EPS. Methods We divided 56 nonuremic albino Wistar rats into 6 groups: control group ( n = 10), daily intraperitoneal (IP) injection of 2 mL isotonic saline for 3 weeks; CG group ( n = 10), daily IP injection of 2 mL/200 g chlorhexidine gluconate (CG) for 3 weeks; resting group ( n = 10), daily IP injection of CG (0 – 3 weeks) plus peritoneal rest (4 – 6 weeks). After 3 weeks of being injected with CG (0 – 3 weeks), a fourth group ( n = 9) was treated with 100 mg/L enalapril (ENA group); a fifth group ( n = 10) was treated with 80 mg/L valsartan (VAL group), and a sixth group ( n = 7) was treated with 100 mg/L enalapril + 80 mg/L valsartan (ENA+VAL group) in drinking water for an additional 3 weeks (4 – 6 weeks). At the end, a 1-hour peritoneal equilibration test was performed with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio of urea (D/P urea), dialysate WBC count, ultrafiltration volume (UF), and morphological changes of parietal peritoneum were examined. Results Exposure to CG for 3 weeks resulted in alterations in peritoneal transport (increased D/P urea, decreased UF volume; p < 0.05) and morphology (increased inflammation, neovascularization, fibrosis, and peritoneal thickness; p < 0.05). Peritoneal rest had some beneficial effect only on UF failure and dialysate cell count ( p < 0.05). However, RAS blockade was more effective than peritoneal rest with respect to UF volume, vascularity ( p < 0.05), and peritoneal thickness ( p > 0.05). Dual blockade of RAS had no additional beneficial effects. Conclusion We suggest that RAS blockade either with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may be a more effective option than resting in the management of EPS.
Collapse
Affiliation(s)
- Devrim Bozkurt
- Departments of Nephrology, Ege University, Izmir, Turkey
| | - Pinar Cetin
- Departments of Nephrology, Ege University, Izmir, Turkey
| | - Savas Sipahi
- Departments of Nephrology, Ege University, Izmir, Turkey
| | - Ender Hur
- Departments of Nephrology, Ege University, Izmir, Turkey
| | - Hasim Nar
- Departments of Nephrology, Ege University, Izmir, Turkey
| | | | | | - Soner Duman
- Departments of Nephrology, Ege University, Izmir, Turkey
| |
Collapse
|
42
|
Abstract
Standard peritoneal dialysis (PD) solutions with low pH and containing high concentrations of lactate and glucose have been demonstrated to negatively affect the peritoneal membrane, mesothelial cell viability, residential peritoneal cells, and also to inhibit phagocytic functions. An increasing body of experimental evidence supports the idea that the peritoneal hypervascularization and fibrosis observed in long-term PD are causally related to the acute and chronic toxicity of conventional PD solutions. A Physioneal (lactate/bicarbonate mixed buffer pH 7-7.4), Physioneal, Extraneal (7.5% icodextrin), Nutrineal (1.1% amino-acid-containing solution) regimen, for example, offers a significant reduction in carbohydrate load (approximately 40-50%), lower exposure to and absorption of glucose degradation products, reduced oxidative stress, and improved volume control when compared with a first-generation DDDD (4 x Dianeal) regimen. The positive aspects of each solution that we have observed in our patients allow a recommendation on the potential benefit of using these solutions in children treated with PD. In fact, data from the literature as well as the results of the studies reported in this paper show that in children the application of neutral pH bicarbonate/lactate-buffered solution for the standard nighttime APD prescription, icodextrin solution for a long daytime dwell, and AA-based solution in malnourished patients is safe and effective. Extended clinical trials should be encouraged to better define the PD schedules for the combined use of these solutions that may be associated with the best clinical efficacy and the highest level of biocompatibility.
Collapse
|
43
|
Saxena R. Pathogenesis and treatment of peritoneal membrane failure. Pediatr Nephrol 2008; 23:695-703. [PMID: 17891546 DOI: 10.1007/s00467-007-0580-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 07/08/2007] [Accepted: 07/09/2007] [Indexed: 10/22/2022]
Abstract
Peritoneal dialysis (PD) is a viable treatment option for end stage renal disease (ESRD) patients worldwide. PD may provide a survival advantages over hemodialysis (HD) in the early years of treatment. However, the benefits of PD are short-lived, as peritoneal membrane failure ensues in many patients, owing mainly to structural and functional changes in the peritoneal membrane from the use of conventional bio-incompatible PD solutions, which are hyperosmolar, acidic, have lactate buffer and contain high concentrations of glucose and glucose degradation products (GDPs). Current data suggest that chronic exposure of the peritoneum to contemporary PD fluids provokes activation of various inflammatory, fibrogenic and angiogenic cytokines, interplay of which leads to progressive peritoneal fibrosis, vasculopathy and neoangiogenesis. There is emerging evidence that peritoneal vascular changes are mainly responsible for increased solute transport and ultrafiltration failure in long-term PD. However, the precise pathophysiologic mechanisms initiating and propagating peritoneal fibrosis and angiogenesis remain elusive. The protection of the peritoneal membrane from long-term toxic and metabolic effects of high GDP-containing, conventional, glucose-based solutions is a prime objective to improve PD outcome. Recent development of new, more biocompatible, PD solutions should help to preserve peritoneal membrane function, promote ultrafiltration, improve nutritional status and, hopefully, preserve peritoneal membrane and improve overall PD outcomes. Elucidation of molecular mechanisms involved in the cellular responses leading to peritoneal fibrosis and angiogenesis spurs new therapeutic strategies that might protect the peritoneal membrane against the consequences of longstanding PD.
Collapse
Affiliation(s)
- Ramesh Saxena
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8856, USA.
| |
Collapse
|
44
|
Luo P, Tan Z, Zhang Z, Li H, Mo Z. Inhibitory Effects of Salvianolic Acid B on the High Glucose-Induced Mesangial Proliferation via NF-.KAPPA.B-Dependent Pathway. Biol Pharm Bull 2008; 31:1381-6. [PMID: 18591779 DOI: 10.1248/bpb.31.1381] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Pei Luo
- West China School of Pharmacy, Sichuan University
| | | | | | - Honghao Li
- West China School of Pharmacy, Sichuan University
| | - Zhengji Mo
- West China School of Pharmacy, Sichuan University
| |
Collapse
|
45
|
Rodrigues AS, Martins M, Korevaar JC, Silva S, Oliveira JC, Cabrita A, Castro e Melo J, Krediet RT. Evaluation of peritoneal transport and membrane status in peritoneal dialysis: focus on incident fast transporters. Am J Nephrol 2007; 27:84-91. [PMID: 17284895 DOI: 10.1159/000099332] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 01/05/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM The determinants of baseline fast solute transport are still unclear. We prospectively investigated the relationship of peritoneal solute transport with markers of inflammation, angiogenesis, and membrane status, with a focus on fast transporters. METHODS Seventy-one incident peritoneal dialysis patients were assessed with baseline and annual peritoneal equilibration tests, using a 3.86% glucose dialysis solution. Residual renal function and markers of inflammation, including systemic and intraperitoneal interleukin-6 (IL-6), effluent cancer antigen 125 (CA-125), and vascular endothelial growth factor (VEGF) appearance rates (ARs), were investigated. The time course of the dialysate-to-plasma ratio of creatinine (D/P creatinine ratio) and its relationship with the biomarkers were investigated by a mixed linear model. RESULTS Incident fast/fast average transporters had a similar age, diabetes prevalence, and serum and effluent IL-6 levels, but significantly higher levels of CA-125 and VEGF ARs than the slow/slow average group; the D/P creatinine ratio was not correlated with systemic IL-6, but was correlated with effluent CA-125 AR (r = 0.45, p < 0.0001) and VEGF AR (r = 0.52, p < 0.0001). The D/P creatinine ratio decreased with a U-shaped profile (p = 0.02). Intraperitoneal IL-6 was the significant and positive determinant of the time course of the D/P creatinine ratio (p < 0.0001). Effluent CA-125 decreased with time on peritoneal dialysis (p = 0.013). CONCLUSIONS Baseline peritoneal fast transport was not associated with systemic inflammation, but was related to peritoneal locally produced substances able to mediate transitory hyperpermeability. The D/P creatinine ratio changed during the follow-up period with a U-shaped profile. This was associated with effluent IL-6 and partly with VEGF. CA-125 decreased throughout the follow-up period.
Collapse
Affiliation(s)
- Anabela S Rodrigues
- Department of Nephrology, Hospital Geral de Santo António, University of Porto, Porto, Portugal.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Higuchi C, Nishimura H, Sanaka T. Biocompatibility of peritoneal dialysis fluid and influence of compositions on peritoneal fibrosis. Ther Apher Dial 2007; 10:372-9. [PMID: 16911191 DOI: 10.1111/j.1744-9987.2006.00391.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conventional peritoneal dialysis fluid (PDF) is a bioincompatible solution because of several components. These unphysiological compositions might contribute to the development of peritoneal fibrosis. In the present overview we summarize the influence of each composition of PDF (acidic pH, high concentration of glucose and glucose degradation products; advanced glycation end-products and lactate) on the peritoneal fibrotic changes in long peritoneal dialysis (PD) patients. We also summarized the report of new approaches to the prevention of peritoneal fibrosis in Japan.
Collapse
Affiliation(s)
- Chieko Higuchi
- Division of Internal Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
| | | | | |
Collapse
|
47
|
Noh H, Kim JS, Han KH, Lee GT, Song JS, Chung SH, Jeon JS, Ha H, Lee HB. Oxidative stress during peritoneal dialysis: implications in functional and structural changes in the membrane. Kidney Int 2006; 69:2022-8. [PMID: 16641917 DOI: 10.1038/sj.ki.5001506] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Progressive peritoneal fibrosis, membrane hyperpermeability, and ultrafiltration failure have been observed in patients on long-term peritoneal dialysis (PD). The present study tested the hypothesis that reactive oxygen species (ROS) generated by conventional PD solution (PDS) mediate functional and structural alterations of peritoneal membrane in vivo. Sprague-Dawley rats were randomized to control, PDS, PDS with an antioxidant, and PDS with an angiotensin II (Ang II) receptor blocker. Commercial PDS containing 3.86% glucose (20-30 ml) with or without N-acetylcystein (NAC) 10 mM or losartan 5 mg/kg was administered intraperitoneally twice a day for 12 weeks. Control rats received sham injection. Rats treated with PDS had significantly lower drain volume and D(4)/D(0) glucose, but higher D(4)/P(4) creatinine and increased membrane thickness and endothelial NOS (eNOS) expression compared to control rats. Omental transforming growth factor (TGF)-beta1, vascular endothelial growth factor (VEGF), collagen I, and heat-shock protein (hsp) 47 expression and lipid peroxide levels and dialysate VEGF and Ang II concentrations were significantly increased in rats treated with PDS compared to control. All of these changes were prevented by both NAC and losartan. In conclusion, the present study demonstrates that ROS generated by conventional PDS are, in large part, responsible for peritoneal fibrosis and membrane hyperpermeability. We suggest that antioxidants or Ang II receptor blockers may allow better preservation of the structural and functional integrity of the peritoneal membrane during long-term PD.
Collapse
Affiliation(s)
- H Noh
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Ahmad M, Shah H, Pliakogiannis T, Oreopoulos DG. Prevention of membrane damage in patient on peritoneal dialysis with new peritoneal dialysis solutions. Int Urol Nephrol 2006; 39:299-312. [PMID: 17004033 DOI: 10.1007/s11255-006-9064-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
Abstract
Peritoneal dialysis (PD) is now an established and successful alternative to hemodialysis. Multiple studies have confirmed its equivalent dialysis adequacy, mortality and fluid balance status, at least for the first 4-5 years. Peritoneal membrane failure is now one of the leading cause of technique failure. This review describes the role of glucose, glucose degradation product, pH, lactate, advanced glycosylation end product (AGE) in causing this membrane damage, and gives insight how the use of newer peritoneal dialysis fluids (PDFs) containing icodextrin, amino acids and bicarbonate buffer can prevent peritoneal membrane damage.
Collapse
Affiliation(s)
- Mufazzal Ahmad
- Department of Nephrology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto m5b2e8, Ontario, Canada.
| | | | | | | |
Collapse
|
49
|
Chin AI, Yeun JY. Encapsulating Peritoneal Sclerosis: An Unpredictable and Devastating Complication of Peritoneal Dialysis. Am J Kidney Dis 2006; 47:697-712. [PMID: 16564950 DOI: 10.1053/j.ajkd.2005.12.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 12/28/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew I Chin
- University of California Davis, Sacramento, CA 95817, USA
| | | |
Collapse
|
50
|
Martikainen T, Ekstrand A, Honkanen E, Teppo AM, Grönhagen-Riska C. Do interleukin-6, hyaluronan, soluble intercellular adhesion molecule-1 and cancer antigen 125 in dialysate predict changes in peritoneal function? A 1-year follow-up study. ACTA ACUST UNITED AC 2006; 39:410-6. [PMID: 16257844 DOI: 10.1080/00365590500386809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Diminishing ultrafiltration and dialysis adequacy may limit the long-term use of peritoneal dialysis (PD). Inflammation may play a role in changes in peritoneal function. This study was designed to evaluate alterations in peritoneal function and soluble factors in dialysate during a 1-year follow-up period. MATERIAL AND METHODS A personal dialysis capacity test was performed at the start of the study and after 6 and 12 months in 20 patients in order to determine dialysis adequacy and membrane characteristics. Dialysate was collected during the test days for analyses of interleukin-6 (IL-6), soluble intercellular adhesion molecule-1, hyaluronan and cancer antigen 125 (CA125). RESULTS There were no significant changes in dialysis adequacy or membrane characteristics during the 1-year follow-up period. The appearance rate of IL-6 in dialysate increased significantly (419.8+/-63.3 at the start, 784.1+/-136.4 after 6 months and 1149.3+/-252.2 ng/24 h after 12 months; p=0.006) during follow-up. Furthermore, the appearance rate of CA125 increased throughout the study in patients using icodextrin, but decreased slightly in patients using only conventional dialysis solutions. CONCLUSIONS There were no major changes in dialysis adequacy or membrane characteristics during the follow-up period, but increased IL-6 in dialysate may reflect peritoneal inflammation, which may lead to long-term alterations in the peritoneal membrane. Icodextrin may have a preventive effect on the longevity of the peritoneal membrane.
Collapse
Affiliation(s)
- Terhi Martikainen
- Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | |
Collapse
|