1
|
Kobayashi R, Kinugasa S, Kamano D, Sumura R, Kakiwaki H, Haze T, Ono K, Yanagi M, Tamura K, Ishibashi Y. Impact of compliance with salt management guidelines before dialysis introduction on peritoneal dialysis technique survival: The importance of pre-dialysis care and education. Ther Apher Dial 2024. [PMID: 38783565 DOI: 10.1111/1744-9987.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) is a mode of therapy in which the patients themselves actively participate in the care of their own disease. We examined a possible association of salt reduction before starting dialysis with PD technique survival. METHODS This retrospective cohort study included 42 patients who started PD between April 2014 and March 2018. Participants were allocated to two groups based on their estimated daily salt intake before the initiation of dialysis: patients with an estimated daily salt intake <6 g/day were allocated to the appropriate salt intake group (AS group), while the rest were assigned to the high salt intake group (HS group). RESULTS During a median follow-up of 47 months, PD technique survival, defined by death or transition to hemodialysis, was significantly lower in the HS group compared to the AS group. CONCLUSION Successful salt reduction before dialysis introduction is associated with better PD technique survival.
Collapse
Affiliation(s)
- Ryu Kobayashi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoshi Kinugasa
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Daisuke Kamano
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Rena Sumura
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hirotoshi Kakiwaki
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tatsuya Haze
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keisuke Ono
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mai Yanagi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshitaka Ishibashi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| |
Collapse
|
2
|
Iorga C, Iorga CR, Andreiana I, Stancu SH, Constantin T, Strambu V. Peritoneal Dialysis-Induced Encapsulating Peritonitis: Diagnostic and Therapeutic Challenges in Women with Benign Gynecological Pathology. J Clin Med 2024; 13:2921. [PMID: 38792461 PMCID: PMC11121892 DOI: 10.3390/jcm13102921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a form of renal function substitution. Medical or surgical treatments can be applied, but morbidity and mortality have high rates. This condition typically presents clinically as an intestinal obstruction caused by the inclusion of the intestinal loops in the peritoneal fibrous membrane. Methods: Herein, we present data from a single tertiary surgery center that has dedicated teams for patients receiving dialysis. Over 12 years, we analyzed a group of 63 patients admitted for catheter replacement/removal or for acute surgical pathology. In five cases (7.9%), we diagnosed EPS. Two patients with EPS presented with atypical abdominal pathologies requiring emergency surgery: one case of hemoperitoneum caused by a ruptured ovarian cyst and one case of uterine fibroids and metrorrhagia. Results: The definitive diagnoses were established intraoperatively and by analyzing the morpho-pathological changes in the peritoneum. The possible intraoperative challenges included laborious dissection, difficulties in restoring the correct anatomical landmarks, an increased duration of the surgical intervention and a high rate of incidents and accidents. Conclusions: The aim of the present study was to emphasize the possibility of other surgical pathologies overlapping with EPS, increasing the complexity of the surgical intervention.
Collapse
Affiliation(s)
- Cristian Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Cristina Raluca Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Iuliana Andreiana
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Nephrology Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Simona Hildegard Stancu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Nephrology Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Traian Constantin
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Department of Urology, “Prof. Dr. Th. Burghele” Hospital, 050652 Bucharest, Romania
| | - Victor Strambu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (I.A.); (S.H.S.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| |
Collapse
|
3
|
Nakayama T, Morimoto K, Uchiyama K, Washida N, Kusahana E, Hama EY, Mitsuno R, Tonomura S, Yoshimoto N, Hishikawa A, Hagiwara A, Azegami T, Yoshino J, Monkawa T, Yoshida T, Yamaguchi S, Hayashi K. Efficacy of sucrose and povidone-iodine mixtures in peritoneal dialysis catheter exit-site care. BMC Nephrol 2024; 25:151. [PMID: 38698327 PMCID: PMC11064401 DOI: 10.1186/s12882-024-03591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Exit-site infection (ESI) is a common recurring complication in patients undergoing peritoneal dialysis (PD). Sucrose and povidone-iodine (SPI) mixtures, antimicrobial ointments that promote wound healing, have been used for the treatment of ulcers and burns, but their efficacy in exit-site care is still unclear. METHODS This single-center retrospective observational study included patients who underwent PD between May 2010 and June 2022 and presented with episodes of ESI. Patients were divided into SPI and non-SPI groups and followed up from initial ESI onset until PD cessation, death, transfer to another facility, or June 2023. RESULTS Among the 82 patients (mean age 62, [54-72] years), 23 were treated with SPI. The median follow-up duration was 39 months (range, 14-64), with an overall ESI incidence of 0.70 episodes per patient-year. Additionally, 43.1% of second and 25.6% of third ESI were caused by the same pathogen as the first. The log-rank test demonstrated significantly better second and third ESI-free survival in the SPI group than that in the non-SPI group (p < 0.01 and p < 0.01, respectively). In a Cox regression analysis, adjusting for potential confounders, SPI use was a significant predictor of decreased second and third ESI episodes (hazard ratio [HR], 0.22; 95% confidence interval [CI], 0.10-0.52 and HR, 0.22; 95%CI, 0.07-0.73, respectively). CONCLUSIONS Our results showed that the use of SPI may be a promising option for preventing the incidence of ESI in patients with PD. TRIAL REGISTRATION This study was approved by the Keio University School of Medicine Ethics Committee (approval number 20231078) on August 28, 2023. Retrospectively registered.
Collapse
Affiliation(s)
- Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Ei Kusahana
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Eriko Yoshida Hama
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Ryunosuke Mitsuno
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shun Tonomura
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Norifumi Yoshimoto
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Akihito Hishikawa
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Aika Hagiwara
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tatsuhiko Azegami
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Jun Yoshino
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Toshiaki Monkawa
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Yamaguchi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan.
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| |
Collapse
|
4
|
Kamiya K, Hatayama N, Tawada M, Asai A, Yamauchi M, Kinashi H, Kunoki S, Yamaguchi M, Mizuno M, Suzuki Y, Banshodani M, Ishimoto T, Naito M, Kawanishi H, Ito Y. Role of endothelial hyaluronan in peritoneal membrane transport and disease conditions during peritoneal dialysis. Sci Rep 2024; 14:7412. [PMID: 38548914 PMCID: PMC10978880 DOI: 10.1038/s41598-024-58148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
Peritoneal membrane dysfunction in peritoneal dialysis (PD) is primarily attributed to angiogenesis; however, the integrity of vascular endothelial cells can affect peritoneal permeability. Hyaluronan, a component of the endothelial glycocalyx, is reportedly involved in preventing proteinuria in the normal glomerulus. One hypothesis suggests that development of encapsulating peritoneal sclerosis (EPS) is triggered by protein leakage due to vascular endothelial injury. We therefore investigated the effect of hyaluronan in the glycocalyx on peritoneal permeability and disease conditions. After hyaluronidase-mediated degradation of hyaluronan on the endothelial cells of mice, macromolecules, including albumin and β2 microglobulin, leaked into the dialysate. However, peritoneal transport of small solute molecules was not affected. Pathologically, hyaluronan expression was diminished; however, expression of vascular endothelial cadherin and heparan sulfate, a core protein of the glycocalyx, was preserved. Hyaluronan expression on endothelial cells was studied using 254 human peritoneal membrane samples. Hyaluronan expression decreased in patients undergoing long-term PD treatment and EPS patients treated with conventional solutions. Furthermore, the extent of hyaluronan loss correlated with the severity of vasculopathy. Hyaluronan on endothelial cells is involved in the peritoneal transport of macromolecules. Treatment strategies that preserve hyaluronan in the glycocalyx could prevent the leakage of macromolecules and subsequent related complications.
Collapse
Affiliation(s)
- Keisuke Kamiya
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
| | - Naoyuki Hatayama
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Mitsuhiro Tawada
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akimasa Asai
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
| | - Mai Yamauchi
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
| | - Shunnosuke Kunoki
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
- Department of Nephrology, Nippon Medical School, Tokyo, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
| | - Masashi Mizuno
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masataka Banshodani
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Hideki Kawanishi
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute City, Aichi, 480-1195, Japan.
| |
Collapse
|
5
|
Kojima D, Washida N, Uchiyama K, Hama EY, Nagasaka T, Kusahana E, Nakayama T, Nagashima K, Sato Y, Morimoto K, Kanda T, Itoh H. The body mass index change is associated with death or hemodialysis transfer in Japanese patients initiating peritoneal dialysis. Ren Fail 2023; 45:2163904. [PMID: 36637000 PMCID: PMC9848317 DOI: 10.1080/0886022x.2022.2163904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A decreased body mass index (BMI) over time is associated with a poor prognosis for patients on hemodialysis. We aimed to examine whether this association also applies to patients with peritoneal dialysis (PD). BMI change was defined as the percentage change in the BMI between the time of PD catheter insertion and six months after its insertion. The association between the BMI change and all-cause mortality or PD discontinuation from six months after PD catheter insertion until October 2021 was investigated. This retrospective cohort study included 122 patients (aged 61.1 ± 12.1 years; 90 males) who underwent PD catheter insertion between January 2008 and March 2020. The median follow-up period was 43.1 (21.2-78.8) months. The median six-month percentage change in the BMI was -2.14 (-5.56-1.84)%, and patients were categorized into tertiles based on their BMI changes. The fully-adjusted Cox regression analysis revealed a significantly higher rate of PD discontinuation or all-cause mortality (hazard ratio (HR): 2.48; 95%; confidence interval (CI): 1.41-4.37) in patients with the lowest tertile (T1, BMI change: < -4.13%) compared to patients with the middle tertile (T2, BMI change: -4.13%-0.67%). The risk was not significantly higher in patients with the highest tertile (T3, BMI change: >0.67%) than those in the T2 group (HR: 1.18; 95% CI: 0.66-2.11). A decreased BMI over time is independently associated with HD transfer or all-cause mortality among patients initiating PD, which highlights the importance of the 6-month BMI change as a novel prognostic marker.
Collapse
Affiliation(s)
- Daiki Kojima
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan,CONTACT Kiyotaka Uchiyama Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eriko Yoshida Hama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoki Nagasaka
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Ei Kusahana
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Takashin Nakayama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Yasunori Sato
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Takeshi Kanda
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Taguchi K, Mitsuishi Y, Ito S, Moriyama T, Fukami K. Encapsulating Peritoneal Sclerosis in a Patient Receiving Peritoneal Dialysis and Glucocorticoid Therapy. Intern Med 2023; 62:3203-3207. [PMID: 37438140 PMCID: PMC10686746 DOI: 10.2169/internalmedicine.1760-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a fatal complication of peritoneal dialysis. A 68-year-old man undergoing peritoneal dialysis for 10 years started receiving daily 50 mg of glucocorticoids for idiopathic pulmonary sclerosis. At the transition to hemodialysis, a peritoneal biopsy was performed, which demonstrated mild histological changes, including no fibrin formation and mild T lymphocyte infiltration at the time of 6.5 mg glucocorticoids. However, five months later, he developed EPS when receiving 2.5 mg glucocorticoids. Afterward, over 5 mg daily glucocorticoids were required to avoid the recurrence of EPS. These findings suggest that glucocorticoids may conceal peritoneal inflammation, a main contributor to EPS.
Collapse
Affiliation(s)
- Kensei Taguchi
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Yuta Mitsuishi
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Sakuya Ito
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Tomofumi Moriyama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| |
Collapse
|
7
|
Nakayama M, Miyazaki M, Hamada C, Ito Y, Honda K. Pathophysiology of encapsulating peritoneal sclerosis: lessons from findings of the past three decades in Japan. Clin Exp Nephrol 2023; 27:717-727. [PMID: 37278945 PMCID: PMC10432343 DOI: 10.1007/s10157-023-02360-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/10/2023] [Indexed: 06/07/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS), a condition with a high mortality rate, is a serious complication of peritoneal dialysis (PD). In Japan, EPS became a central issue in the clinical setting during the mid-90s and the beginning of this century. However, following the introduction of biocompatible neutral PD solutions containing lower levels of glucose degradation products, the incidence and clinical severity of EPS has been greatly lessened. During the past three decades, the etiology of EPS has been elucidated by findings obtained by peritoneal biopsy, laparoscopy, and surgical intervention. Accumulating findings suggest the need for a paradigm change on the nature of EPS pathophysiology; notably, EPS appears not to reflect peritoneal sclerosis per se, but rather the formation of a neo-membrane as a biological reaction to peritoneal injury. This narrative review looks back on the history of EPS in Japan, and discusses EPS pathophysiology, the impact of neutral PD solution on peritoneal protection, and a future novel diagnostic approach, ultra-fine endoscope, for the identification of patients at high risk of EPS.
Collapse
Affiliation(s)
- Masaaki Nakayama
- St Luke's International Hospital, Kidney Center, Akashi-cho 9-1, Chuo-ku, Tokyo, Japan.
| | | | | | | | | |
Collapse
|
8
|
Fukui S, Mizuno M, Tawada M, Suzuki Y, Kojima H, Matsukawa Y, Imai M, Kim H, Kinashi H, Mizutani M, Minoshima K, Maruyama S, Ito Y. Peritoneal Expression of Membrane Complement Regulators Is Decreased in Peritoneal Dialysis Patients with Infected Peritonitis. Int J Mol Sci 2023; 24:ijms24119146. [PMID: 37298097 DOI: 10.3390/ijms24119146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
In peritoneal dialysis (PD) patients, fungi and Pseudomonas aeruginosa are considered important causative microorganisms for peritonitis with poor prognosis. Our objective was to explore expressions of membrane complement (C) regulators (CRegs) and tissue injuries in the peritoneum of patients with PD-related peritonitis, including fungal and Pseudomonas aeruginosa peritonitis. In peritoneal biopsy tissues obtained at PD catheter removal, we investigated the severity of peritonitis-associated peritoneal injuries and the expression of CRegs, CD46, CD55, and CD59 against peritoneal tissues without any episode of peritonitis. In addition, we evaluated peritoneal injuries among fungal and Pseudomonas aeruginosa-peritonitis (P1) and Gram-positive bacterial peritonitis (P2). We also observed deposition of C activation products such as activated C and C5b-9 and measured sC5b-9 in the PD fluid of patients. As a result, the severity of peritoneal injuries correlated inversely with the expression of peritoneal CRegs. Peritoneal CReg expression in peritonitis was significantly reduced compared to no peritonitis. Peritoneal injuries were more severe in P1 than in P2. CReg expression was further decreased and C5b-9 further increased in P1 than in P2. In conclusion, severe peritoneal injuries due to fungal and Pseudomonas aeruginosa-peritonitis decreased CReg expression and increased deposition of activated C3 and C5b-9 in the peritoneum, suggesting that peritonitis, particularly fungal and Pseudomonas aeruginosa-peritonitis, might induce susceptibility to further peritoneal injuries due to excessive C activation.
Collapse
Affiliation(s)
- Sosuke Fukui
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mitsuhiro Tawada
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Hiroshi Kojima
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Masaki Imai
- Department of Immunology, Nagoya City University, Nagoya 467-8601, Japan
| | - Hangsoo Kim
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| | | | | | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute 480-1195, Japan
| |
Collapse
|
9
|
Piltcher-da-Silva R, Petry JF, de Araujo Freitas AL, Rhoden GV, Jasinski G, Piltcher-Recuero M, Bettini LFC, Aguilera YSH, Leme JEG, da Costa MAR, Coelho JCU. Encapsulating peritoneal sclerosis post liver transplant and peritoneal dialysis: case report and literature review. J Surg Case Rep 2023; 2023:rjad193. [PMID: 37082649 PMCID: PMC10112950 DOI: 10.1093/jscr/rjad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 04/22/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare and debilitating condition. A fibrocollagenous membrane, which promotes encasement of the small intestine leaving a cocoon-like appearance, takes place. It is mainly associated with peritoneal infections, medications, peritoneal dialysis and systemic inflammatory diseases. Diagnosis is based on clinical history, intestinal obstruction and imaging exam. We report a case of EPS in a 68-year-old man with a medical history of liver transplantation and peritoneal dialysis, complaining of obstructive bowel symptoms.
Collapse
Affiliation(s)
- Rodrigo Piltcher-da-Silva
- Correspondence address. General and Digestive Surgery Service, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil. Tel: 55 53 999242266; E-mail:
| | - João Francisco Petry
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Gabriel Jasinski
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Yan Sacha Hass Aguilera
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Júlio Cezar Uili Coelho
- General and Digestive Surgery Service, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| |
Collapse
|
10
|
Kobayashi K, Ozeki T, Kim H, Imai M, Kojima H, Iguchi D, Fukui S, Suzuki M, Suzuki Y, Maruyama S, Ito Y, Mizuno M. Long-term peritoneal dialysate exposure modulates expression of membrane complement regulators in human peritoneal mesothelial cells. Front Med (Lausanne) 2022; 9:972592. [PMID: 36619632 PMCID: PMC9815709 DOI: 10.3389/fmed.2022.972592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
The membrane complement regulators (CRegs) CD46, CD55, and CD59 are highly expressed on human peritoneal mesothelial cells. However, how mesothelial CRegs change according to the peritoneal dialysis (PD) history of patients has remained unclear. We therefore examined longitudinal changes in CRegs in primary cultured mesothelial cells from PD patients (human peritoneal mesothelial cells; HPMCs) and examined which components of PD fluid (PDF) affect CRegs in vitro. We measured levels of soluble C5b-9 in overnight-dwelling PDF in PD patients and also evaluated changes in CRegs expression on HPMCs collected from PDF using flow cytometry and polymerase chain reaction at a 1-year interval of PD therapy. We also evaluated changes in CReg expressions with stimulation by each component of PDF (glucose, lactic acid and pH) using the Met5A human mesothelial cell line. Levels of sC5b-9 in PDF decreased significantly during 1 year, while expressions of CD46 and CD59 proteins and mRNAs increased significantly in HPMCs during 1 year. Analyzing Met-5A cells, we observed that expressions of the three CRegs were increased by glucose and lactic acid in a concentration-dependent manner, but conversely that expressions of CRegs were decreased by lower pH stimulation. History of PD might influence expression of CRegs by HPMCs through properties of PDF such as glucose, lactic acid, and pH. These results suggest that mesothelial cells may alter expression of CRegs for the purpose of protecting the peritoneum and the presence of PDF might affect peritoneal homeostasis associated with the complement system.
Collapse
Affiliation(s)
- Kazuma Kobayashi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshikazu Ozeki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hangsoo Kim
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Imai
- Department of Immunology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kojima
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Iguchi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sosuke Fukui
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Suzuki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan,*Correspondence: Masashi Mizuno, ,
| |
Collapse
|
11
|
Pepereke S, Shah AD, Brown EA. Encapsulating peritoneal sclerosis: Your questions answered. Perit Dial Int 2022; 43:119-127. [PMID: 36189954 DOI: 10.1177/08968608221125606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome hallmarked by the formation of a fibrous cocoon encapsulating the bowel resulting in morbidity and mortality. EPS is most frequently associated with peritoneal dialysis (PD), particularly with its discontinuation. While EPS is one of the most feared complications of PD, the majority of patients receiving PD will not go on to develop EPS. Risk factors for development include time on PD, some types of peritonitis and discontinuation of PD. Owing to its rarity, much of the knowledge of EPS comes from case series and registries and treatments are extrapolated from low-quality evidence. Malnutrition is a significant driver of mortality, and nutritional support is critical in management. We present a case of EPS and frequently asked questions including the definition, diagnosis, epidemiology, pathophysiology, risk factors, role of infection, management and roles of nutrition and surgery.
Collapse
Affiliation(s)
- Shingai Pepereke
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Ankur D Shah
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| |
Collapse
|
12
|
Kawanishi H. Historical overview and current practice of peritoneal dialysis in Japan. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00438-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractIn the early days of peritoneal dialysis (PD) therapy, its limited duration and peritoneal deterioration were argued to be its disadvantages. Biocompatible solutions and hybrid therapy have been used in Japan to overcome these issues, which resulted in a decrease in encapsulating peritoneal sclerosis (EPS) incidence and an extension of PD continuation; these results have been disseminated worldwide. Peritoneal dialysis outcomes and practice patterns study (PDOPPS), a prospective observational study, has begun to confirm the outcomes of PD therapy, and sufficient evidence has been published, which has influenced the preparation of PD guidelines. Current thinking about PD emphasizes the need to maintain quality of life and life goals as care goals for patients and to provide high-quality care. However, we must conduct basic research on the prevention of peritoneal deterioration.
Collapse
|
13
|
Hamada C. Relationship between laparoscopic and microscopic findings of peritoneum in peritoneal dialysis patients. J Artif Organs 2022:10.1007/s10047-022-01344-1. [PMID: 35920938 DOI: 10.1007/s10047-022-01344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 06/15/2022] [Indexed: 10/16/2022]
Abstract
Long-term exposure to the peritoneal dialysis solution (PDS) causes functional and morphological alterations that diminish the efficacy of peritoneal dialysis (PD). Macroscopic and microscopic findings, submesothelial compact zone (SMC) thickness and vascular patency, were associated with PD duration. The relationship between microscopic and laparoscopic morphological findings in PD patients was determined. A total of 78 laparoscopic intraperitoneal findings were recorded during PD catheter removal and 45 peritoneal tissues were obtained from the anterior parietal peritoneum. We examined macroscopic morphological findings in both parietal and visceral peritoneums and bowel movement and assessed the score semiquantitatively. SMC thickness and vascular patency were examined as microscopic findings. Total laparoscopic finding's score (LFS) and microscopic findings, SMC thickness and vascular patency, were associated with PD duration. Total LFS was related to SMC thickness in both visceral and parietal peritoneum, whereas it was related to vascular patency in parietal but not in visceral peritoneum. There was no relationship between microscopic findings and peritoneal surface color, properties, vasculopathy, and adhesion. Total LFS in patients with newly formed membrane and omentum atrophy was higher than in those without. There was a significant relationship between microscopic and laparoscopic findings in PD patients. It is important to evaluate laparoscopic findings in more PD patients to find the predictive findings of encapsulating peritoneal sclerosis development.
Collapse
Affiliation(s)
- Chieko Hamada
- Faculty of Health Science and Nursing, Juntendo University, Tokyo, Japan. .,Faculty of Health Science and Nursing, Juntendo University, 3-7-33 Omiya, Mishima, Shizuoka, 411-8787, Japan.
| |
Collapse
|
14
|
Hama EY, Uchiyama K, Nagasaka T, Kusahana E, Nakayama T, Yasuda I, Morimoto K, Washida N, Itoh H. High body mass index is a risk factor for transition to hemodialysis or hybrid therapy and peritoneal dialysis-related infection in Japanese patients undergoing peritoneal dialysis. Int Urol Nephrol 2022; 54:3193-3202. [PMID: 35759207 DOI: 10.1007/s11255-022-03252-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Obesity may negatively impact the clinical outcomes of patients undergoing peritoneal dialysis (PD). However, the impact of obesity on PD-related outcomes remains unclear. We herein examined the association of high body mass index (BMI) with complete hemodialysis (HD) transfer, transition to HD and PD/HD hybrid therapy, peritonitis, catheter exit-site and tunnel infection (ESI/TI), and heart failure-related hospitalization. METHODS This retrospective cohort study included 120 patients who underwent PD-catheter insertion between January 2008 and June 2018. BMI ≥ 25 kg/m2 at the time of PD-catheter insertion was defined as high BMI, and its association with outcomes was analyzed using the log-rank test and Cox proportional hazards models. RESULTS The follow-up duration was 46.2 (23.3-75.3) months. The time until transfer to HD and hybrid therapy was significantly shorter in the high BMI group than that in the low BMI group, whereas the time until HD transfer was not significantly different between the two groups (P < 0.001 and 0.18, respectively). Peritonitis-free and ESI/TI-free survivals were significantly shorter in the high BMI group than those in the low BMI group (P = 0.006 and 0.03, respectively). After adjusting for age, sex, diabetes mellitus, and estimated glomerular filtration rate, high BMI remained a significant risk factor for transferring to HD and hybrid therapy, peritonitis, and ESI/TI (hazard ratio [HR] 2.60, P < 0.001; HR 2.08, P = 0.01; HR 2.64, P = 0.02, respectively). CONCLUSION BMI ≥ 25 kg/m2 is a risk factor for transition to HD and hybrid therapy, peritonitis, and ESI/TI, but not for complete HD transfer in Japanese patients with PD.
Collapse
Affiliation(s)
- Eriko Yoshida Hama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
| | - Tomoki Nagasaka
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Ei Kusahana
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashin Nakayama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Itaru Yasuda
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Naoki Washida
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
15
|
Bartosova M, Zarogiannis SG, Schmitt CP. How peritoneal dialysis transforms the peritoneum and vasculature in children with chronic kidney disease-what can we learn for future treatment? Mol Cell Pediatr 2022; 9:9. [PMID: 35513740 PMCID: PMC9072612 DOI: 10.1186/s40348-022-00141-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
Children with chronic kidney disease (CKD) suffer from inflammation and reactive metabolite-induced stress, which massively accelerates tissue and vascular aging. Peritoneal dialysis (PD) is the preferred dialysis mode in children, but currently used PD fluids contain far supraphysiological glucose concentrations for fluid and toxin removal and glucose degradation products (GDP). While the peritoneal membrane of children with CKD G5 exhibits only minor alterations, PD fluids trigger numerous molecular cascades resulting in major peritoneal membrane inflammation, hypervascularization, and fibrosis, with distinct molecular and morphological patterns depending on the GDP content of the PD fluid used. PD further aggravates systemic vascular disease. The systemic vascular aging process is particularly pronounced when PD fluids with high GDP concentrations are used. GDP induce endothelial junction disintegration, apoptosis, fibrosis, and intima thickening. This review gives an overview on the molecular mechanisms of peritoneal and vascular transformation and strategies to improve peritoneal and vascular health in patients on PD.
Collapse
Affiliation(s)
- Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Sotirios G Zarogiannis
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
| | | |
Collapse
|
16
|
Kunin M, Beckerman P. The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis. MEMBRANES 2022; 12:membranes12030318. [PMID: 35323792 PMCID: PMC8954812 DOI: 10.3390/membranes12030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.
Collapse
Affiliation(s)
- Margarita Kunin
- Correspondence: ; Tel.: +97-235-302-581; Fax: 97-235-302-582
| | | |
Collapse
|
17
|
Kusahana E, Uchiyama K, Yamaguchi N, Hirashima M, Togashi T, Yamamoto Y, Imai M, Ashida M, Yamamura K, Nakayama T, Yasuda I, Morimoto K, Washida N, Itoh H. Self-assessment sheet submission rate predicts technique survival in patients initiating peritoneal dialysis. Nephrology (Carlton) 2022; 27:501-509. [PMID: 35166424 DOI: 10.1111/nep.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
AIM Patients play a crucial role in preventing peritoneal dialysis (PD)-related events, including peritonitis and fluid overload, as PD procedures are mainly carried out at home. We asked patients to submit a PD self-assessment sheet at each outpatient visit in our daily clinical practice and evaluated its usefulness for outcomes in patients initiating PD. METHODS This retrospective cohort study included patients who underwent PD catheter insertion between January 2008 and October 2018. The submission rate of a PD self-assessment sheet was calculated from medical records until PD cessation or study completion (October 2020). The association between the submission rate and technique survival was analysed. RESULTS Among the 105 recruited patients (78 men, 60.4 ± 12.2 years), 44 discontinued PD and transferred to haemodialysis during the study period. The follow-up was 52.3 (28.7-79.3) months, and the median submission rate was 78%. The log-rank test showed that technique survival was significantly better in patients with a submission rate ≥ 78% than those with a submission rate < 78% (P = 0.006). The submission rate remained significantly associated with less technique failure (hazard ratio 0.88 per 10%, P = 0.002) by the Cox regression analysis adjusted for age, sex, Charlson comorbidity index, estimated glomerular filtration rate and geriatric nutritional risk index. CONCLUSION The submission rate of a PD self-assessment sheet is useful as a predictor of technique survival in patients initiating PD. Instruction that increases submission may improve technique survival in PD patients. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ei Kusahana
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Nobuko Yamaguchi
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Maiko Hirashima
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Tomoko Togashi
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yuriko Yamamoto
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Michiyo Imai
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Mayumi Ashida
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Keiko Yamamura
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashin Nakayama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Itaru Yasuda
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Naoki Washida
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
18
|
Idei M, Abe M, Tanaka M, Nakata J, Isshiki M, Hino O, Miida T. Effluent N‐terminal expressed in renal cell carcinoma/mesothelin predicts increased peritoneal permeability in patients undergoing peritoneal dialysis. Ther Apher Dial 2021; 26:1014-1022. [DOI: 10.1111/1744-9987.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mayumi Idei
- Department of Clinical Laboratory Medicine Juntendo University Graduate School of Medicine Tokyo Japan
- Medical Technology Innovation Center Juntendo University Tokyo Japan
| | - Masaaki Abe
- Department of Pathology and Oncology Juntendo University Faculty of Medicine Tokyo Japan
| | - Mototsugu Tanaka
- Clinical and Translational Research Center Niigata University Medical and Dental Hospital Niigata Japan
| | - Junichiro Nakata
- Division of Nephrology, Department of Internal Medicine Juntendo University Faculty of Medicine Tokyo Japan
| | - Miwa Isshiki
- Department of Clinical Laboratory Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Okio Hino
- Department of Pathology and Oncology Juntendo University Faculty of Medicine Tokyo Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| |
Collapse
|
19
|
Watanabe-Kusunoki K, Kusunoki Y, Goto J, Kukita K. Liver cirrhosis with encapsulating peritoneal sclerosis after 4 years of peritoneal dialysis: A case report. Medicine (Baltimore) 2021; 100:e28350. [PMID: 34941145 PMCID: PMC8702031 DOI: 10.1097/md.0000000000028350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Encapsulating peritoneal sclerosis (EPS), or abdominal cocoon, is a rare but fatal syndrome characterized by intestinal obstruction owing to adhesions in a diffusely thickened peritoneum. Long-term peritoneal dialysis (PD) for more than 5 years is commonly associated with EPS, while liver cirrhosis also carries a risk of EPS. However, there have been only a few reports that describe a case of EPS complicated with both cirrhosis and PD. We herein describe a case of advanced liver cirrhosis with end-stage renal disease (ESRD) who developed EPS after 4 years of PD and who was successfully recovered by surgery. PATIENT CONCERNS A 58-year-old man with alcoholic liver cirrhosis suffered abdominal pain. The patient had a 4-year history of continuous cycling PD to manage ESRD as well as cirrhotic complications of refractory ascites and hypotension. Laboratory test results showed increased levels of inflammation, and contrast-enhanced computed tomography scan showed dilated loops of small bowel proximal to the site of intestinal obstruction. The patient was suspected to have developed intestinal obstruction owing to EPS. The patient discontinued continuous cycling peritoneal dialysis and switched to hemodiafiltration. DIAGNOSES Laparoscopy revealed a whitish membranous material wrapped around the bowel, especially at the terminal ileum with a narrowed portion, consistent with EPS. INTERVENTIONS Repeated decortication of fibrous peritoneal membranes successfully released the intestinal obstruction. OUTCOMES The postoperative course went well and abdominal pain remained in remission. Because abdominal distension owing to ascites got intolerable in a few days after surgery, a PD catheter was re-inserted and ascitic fluid drainage was resumed with peritoneal lavage. The patient continued hemodiafiltration using vasopressor agents. LESSONS The Cirrhotic patient with ESRD undergoing PD could develop EPS after a short duration of PD.
Collapse
Affiliation(s)
| | - Yoshihiro Kusunoki
- Department of Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Junichi Goto
- Department of Surgery, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Kazutaka Kukita
- Department of Surgery, Sapporo Hokuyu Hospital, Sapporo, Japan
| |
Collapse
|
20
|
Mitochonic acid-5 ameliorates chlorhexidine gluconate-induced peritoneal fibrosis in mice. Med Mol Morphol 2021; 55:27-40. [PMID: 34622315 DOI: 10.1007/s00795-021-00305-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/28/2021] [Indexed: 01/11/2023]
Abstract
Peritoneal fibrosis is a serious complication of long-term peritoneal dialysis, attributable to inflammation and mitochondrial dysfunction. Mitochonic acid-5 (MA-5), an indole-3-acetic acid derivative, improves mitochondrial dysfunction and has therapeutic potential against various diseases including kidney diseases. However, whether MA-5 is effective against peritoneal fibrosis remains unclear. Therefore, we investigated the effect of MA-5 using a peritoneal fibrosis mouse model. Peritoneal fibrosis was induced in C57BL/6 mice via intraperitoneal injection of chlorhexidine gluconate (CG) every other day for 3 weeks. MA-5 was administered daily by oral gavage. The mice were divided into control, MA-5, CG, and CG + MA-5 groups. Following treatment, immunohistochemical analyses were performed. Fibrotic thickening of the parietal peritoneum induced by CG was substantially attenuated by MA-5. The number of α-smooth muscle actin-positive myofibroblasts, transforming growth factor β-positive cells, F4/80-positive macrophages, monocyte chemotactic protein 1-positive cells, and 4-hydroxy-2-nonenal-positive cells was considerably decreased. In addition, reduced ATP5a1-positive and uncoupling protein 2-positive cells in the CG group were notably increased by MA-5. MA-5 may ameliorate peritoneal fibrosis by suppressing macrophage infiltration and oxidative stress, thus restoring mitochondrial function. Overall, MA-5 has therapeutic potential against peritoneal fibrosis.
Collapse
|
21
|
Roy S, Alexander K, Chowdhury MH, Vanguri V, Bodziak K. Encapsulating Peritoneal Sclerosis Presenting after Two Donor Kidney Transplantations: A Case Report and Literature Review. Case Rep Nephrol Dial 2021; 11:204-209. [PMID: 34414212 PMCID: PMC8339504 DOI: 10.1159/000514062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
Encapsulating peritoneal sclerosis is a rare, recurring complication in peritoneal dialysis (PD) patients. With a mortality rate of 51%, it continues to be a therapeutic enigma among clinicians. However, the incidence after kidney transplantation (KT) has rarely been reported. We report a unique case of encapsulating peritoneal sclerosis (EPS), occurring years after failed initial living KT, and diagnosed after second deceased donor kidney transplantation. A 35-year-old male, on prior PD for 4 years, followed by failed KT of 8 years, was presented with abdominal pain, weight loss, and vomiting, 7 months after his second deceased donor KT. An abdominal computed tomography showed intra-abdominal loculated fluid collection, but no obstruction. Exploratory laparotomy revealed extensive peritoneal thickening and blocked intestinal loops. Histopathology was indicative of EPS with fibrous adhesions and sclerotic tissues. Besides restarting his immunosuppressive medications, tamoxifen therapy was initiated as definitive medical management. Currently, he is in clinical remission, follows at transplant clinic, and still experiences episodes of small bowel obstruction. Though the incidence of EPS after KT has been observed sporadically worldwide, none has been reported in the USA. Despite its prevalence in PD patients, therapeutic interventions attempted so far, are not definitive.
Collapse
Affiliation(s)
- Sasmit Roy
- Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | - Kyrstin Alexander
- Division of Renal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Vijay Vanguri
- Division of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kenneth Bodziak
- Division of Renal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
22
|
Uchiyama K, Washida N, Kusahana E, Nakayama T, Morimoto K, Itoh H. Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis. Blood Purif 2021; 51:355-364. [PMID: 34284388 DOI: 10.1159/000517349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD. METHODS Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed. RESULTS This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8-75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, p < 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 < 1.54 than in those with E1W/E0 ≥ 1.54 (p = 0.002, <0.001, and <0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, p = 0.01; HR 2.19, p < 0.001; HR 2.15, p < 0.001, respectively). CONCLUSION Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.
Collapse
Affiliation(s)
- Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Washida
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Ei Kusahana
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohkichi Morimoto
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
23
|
Parikova A, Michalickova K, van Diepen AT, Voska L, Viklicky O, Krediet RT. Do low GDP neutral pH solutions prevent or retard peritoneal membrane alterations in long-term peritoneal dialysis? Perit Dial Int 2021; 42:236-245. [PMID: 34259088 DOI: 10.1177/08968608211027008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several studies have been published in the last decade on the effects of low glucose degradation product (GDP) neutral pH (L-GDP/N-pH) dialysis solutions on peritoneal morphology and function during the long-term PD treatment. Compared to conventional solutions, the impact of these solutions on the morphological and functional alterations of the peritoneal membrane is discussed, including those of effluent proteins that reflect the status of peritoneal tissues. Long-term PD with conventional solutions is associated with the loss of mesothelium, submesothelial and interstitial fibrosis, vasculopathy, and deposition of advanced glycosylation end products (AGEs). L-GDP/N-pH solutions mitigate these alterations, although vasculopathy and AGE deposition are still present. Increased vascular density was found in some studies. Small solute transport increases with PD duration on conventional solutions. Initially, higher values are present on L-GDP/N-pH treatment, but these may be reversible and remain stable with PD duration. Consequently, ultrafiltration (UF) is lower initially but remains stable thereafter. At 5 years, UF and small pore fluid transport are higher, while free water transport decreased only slightly during follow-up. Cancer antigen 125 was initially higher on L-GDP/N-pH solutions, suggesting better mesothelial preservation but decreased during follow-up. Therefore, L-GDP/N-pH solutions may not prevent but reduce and retard the peritoneal alterations induced by continuous exposure to glucose-based dialysis fluids.
Collapse
Affiliation(s)
- Alena Parikova
- Department of Nephrology, Transplant Centre, 48214Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Kristyna Michalickova
- Department of Nephrology, Transplant Centre, 48214Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Luděk Voska
- Department of Pathology, Transplant Centre, 48214Institute for Clinical and Experimental Medicine, Prague, Czech republic
| | - Ondrej Viklicky
- Department of Nephrology, Transplant Centre, 48214Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Raymond T Krediet
- Division of Nephrology, Department of Medicine, 522567Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
Collapse
|
25
|
Kawanishi H, Marshall MR, Zhao J, McCullough K, Robinson B, Pisoni RL, Perl J, Tomo T, Minakuchi J. Mortality, hospitalization and transfer to haemodialysis and hybrid therapy, in Japanese peritoneal dialysis patients. Perit Dial Int 2021; 42:305-313. [PMID: 34002656 DOI: 10.1177/08968608211016127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Survival of peritoneal dialysis (PD) patients in Japan is high, but few reports exist on cause-specific mortality, transfer to haemodialysis (HD) or hybrid dialysis and hospitalisation risks. We aimed to identify reasons for transfer to HD, hybrid dialysis and hospitalisation in the Japan Peritoneal Dialysis and Outcomes Practice Patterns Study. METHODS This observational study included 808 adult PD patients across 31 facilities in Japan in 2014-2017. Information on all-cause and cause-specific mortality and hospitalisation and permanent transfer to HD and PD/HD hybrid therapy were prospectively collected and rates calculated. RESULTS Median follow-up time was 1.66 years where 162 patients transferred to HD, 79 transferred to hybrid dialysis and 74 patients died. All-cause and cardiovascular disease (CVD)-related mortality rates were 5.1 and 1.7 deaths/100 patient-years, respectively. Rates of transfer to HD and hybrid therapy were 11.2 and 5.5 transfers/100 patient-years, respectively. Among HD transfers, 40% were due to infection (including peritonitis), while 20% were due to inadequate solute/water clearance. Eighty-one percent of hybrid dialysis transfers were due to inadequate solute/water clearance. All--cause, peritonitis-related and CVD-related hospitalisation rates were 120.4, 21.1 and 15.6/100 patient-years, respectively. Median hospital length of stay was 19 days. CONCLUSIONS Mortality, hospitalisation and transfer to HD/hybrid dialysis rates are relatively low in Japan compared to many other countries with hybrid transfers, accounting for one-third of dialysis transfers from PD. Further study is needed to explain the high inter-facility variation in hospitalisation rates and how to further reduce hospitalisation rates for Japanese PD patients.
Collapse
Affiliation(s)
| | - Mark R Marshall
- Department of Renal Medicine, Counties Manukau District Health Board, New Zealand
| | - Junhui Zhao
- Arbor Research Collaborative for Health, MI, USA
| | | | | | | | - Jeffrey Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | | | | | | |
Collapse
|
26
|
Murashima M, Hamano T, Abe M, Masakane I. Encapsulating Peritoneal Sclerosis and Mortality Related to Infection in Patients on Combination Once-Weekly Hemodialysis with Peritoneal Dialysis. Am J Nephrol 2021; 52:336-341. [PMID: 33895730 DOI: 10.1159/000515150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous studies showed that the combination of peritoneal dialysis (PD) and once-weekly hemodialysis is associated with lower all-cause and cardiovascular mortality. This study aimed to compare the incidence of encapsulating peritoneal sclerosis (EPS) and infection-related mortality among those on combination therapy and those on PD alone. METHODS This prospective study on the Japanese Renal Data Registry included patients on PD from 2010 to 2014. Subjects were followed up until the end of 2015. Exposure of interest was combination therapy compared with PD alone. Patients who transitioned to combination therapy were matched with those on PD alone by propensity scores. Outcomes were EPS and infection-related mortality. Data were analyzed using Cox regression models. RESULTS Among the matched cohort, 608 and 869 patients were on combination therapy and on PD alone, respectively. Dialysate-to-plasma creatinine (D/P Cr) ratio decreased over time among those on combination therapy, while the ratio increased among those on PD alone (p = 0.01 by the mixed-effects model). During a median follow-up of 2.5 years, 33 experienced EPS and 55 died of infection. Combination therapy was associated with lower infection-related mortality (HR [95% CI]: 0.52 [0.28-0.95]) but not with EPS (HR: 1.21 [0.61-2.40]). Lower mortality was not limited to intra-abdominal infection but also observed for pulmonary infection. Sensitivity analyses considering the effects of dialysis facilities yielded similar results. CONCLUSIONS Combination therapy was associated with lower infection-related mortality. It was also associated with a decline in the D/P Cr ratio over time but not with lower incidence of EPS during the short observation period.
Collapse
Affiliation(s)
- Miho Murashima
- Department of Nephrology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
- Research Subcommittee of Japanese Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Takayuki Hamano
- Department of Nephrology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
- Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Masanori Abe
- Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuto Masakane
- Renal Data Registry Committee, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Yabuki Hospital, Yamagata, Japan
| |
Collapse
|
27
|
Ozeki T, Mizuno M, Iguchi D, Kojima H, Kim H, Suzuki Y, Kinashi H, Ishimoto T, Maruyama S, Ito Y. C1 inhibitor mitigates peritoneal injury in zymosan-induced peritonitis. Am J Physiol Renal Physiol 2021; 320:F1123-F1132. [PMID: 33818127 DOI: 10.1152/ajprenal.00600.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Peritonitis, due to a fungal or bacterial infection, leads to injury of the peritoneal lining and thereby forms a hazard for the long-term success of peritoneal dialysis (PD) and remains a lethal complication in patients with PD. This study investigated whether C1 inhibitor (C1-INH) could protect against the progression of peritoneal injuries with five daily administrations of zymosan after mechanical scraping of the rat peritoneum to mimic fungal peritonitis. Severe peritoneal injuries were seen in this model, accompanied by fibrinogen/fibrin exudation and peritoneal deposition of complement activation products such as activated C3 and C5b-9. However, intraperitoneal injection of C1-INH decreased peritoneal depositions of activated C3 and C5b-9, ameliorated peritoneal thickening, reduced the influx of inflammatory cells, and prevented the production of peritoneal fibrous layers with both one and two doses of C1-INH each day. Our results suggest that C1-INH might be useful to protect against peritoneal injuries after causes of peritonitis such as fungal infection. This clinically available agent may thus help extend the duration of PD.NEW & NOTEWORTHY Peritoneal injuries associated with peritonitis comprise an important issue to prevent long-term peritoneal dialysis (PD) therapy. Here, we showed that C1 inhibitor (C1-INH), as an anticomplement agent, protected against peritoneal injuries in a peritonitis animal model related to fungal infection. Therefore, C1-INH might be useful to protect against peritoneal injuries after peritonitis due to fungal infection. This clinically available agent may thus help extend the duration of PD.
Collapse
Affiliation(s)
- Toshikazu Ozeki
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Mizuno
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Iguchi
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kojima
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hangsoo Kim
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takuji Ishimoto
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
28
|
Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis. Sci Rep 2021; 11:6547. [PMID: 33753829 PMCID: PMC7985378 DOI: 10.1038/s41598-021-86071-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
For peritonitis, a serious complication of peritoneal dialysis (PD), we investigated the relation between duration from the sign (PD effluent abnormalities) to treatment with appropriate antibiotics (ST time) and catheter removal. For 62 PD hospital patients, data of PD-related peritonitis (n = 109) were collected retrospectively. We examined ST time and PD catheter removal times using univariate and multivariate analyses. The catheter removal rate in the delayed ST time group (≥ 24 h) was higher than that in early ST time group (< 24 h) (38 vs. 16%, p = 0.02). Concomitant tunnel infection and delayed ST time were associated with catheter removal (OR [95% CI] 32.3 [3.15–329] and 3.52 [1.11–11.1]). Rates of catheter removal and re-development of peritonitis within 1 month after starting treatment were higher in the delayed ST time group (p = 0.02). PD duration at peritonitis and the first peritonitis episode were associated with delayed ST time (1.02 [1.00–1.04] and 3.42 [1.09–10.7]). Significant association was found between PD catheter removal and the start of treatment more than 24 h after appearance of abnormal effluent. Education for patients about prompt visitation at the onset of peritonitis with long PD duration might improve outcomes.
Collapse
|
29
|
Hamada C, Tomino Y. Recent Understanding of Peritoneal Pathology in Peritoneal Dialysis Patients in Japan. Blood Purif 2021; 50:719-728. [PMID: 33567422 DOI: 10.1159/000510282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
The thin peritoneum covering the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) because it is highly vascularized and has a large body surface area. However, it has been reported that peritoneal membranes affected by peritonitis, as well as those exposed to the nonphysiological high glucose levels containing PD dialysate, may undergo histological and functional changes. Patients undergoing PD may experience encapsulating peritoneal sclerosis (EPS), which is a life-threatening serious complication of PD that can significantly impair activities of daily living. The incidence of EPS was 1.4-7.3% of maintenance PD patients in the 1980s. The incidence has improved to 1.0% after a neutral dialysate became the standard PD treatment in Japan. Furthermore, the pathogenesis of EPS is uncertain although its onset may be explained by the "two-hit theory," in which some factors leading to impairment had an additive effect on simple peritoneal sclerosis. The evaluation of histopathological findings has shown the impact of the neutral dialysate on peritoneal deterioration as well as its role in the development of functional changes. In the present report, we discuss the advances in the understanding of peritoneal deterioration based on histological and macroscopic evaluations of the peritoneum of patients undergoing PD. We also discuss the recent treatment for PD patients.
Collapse
Affiliation(s)
- Chieko Hamada
- Advanced Research Institute for Health Science, Faculty of Medicine, Juntendo University, Tokyo, Japan,
| | - Yasuhiko Tomino
- Asian Pacific Renal Research Promotion Office, Medical Corporation SHOWAKAI, Tokyo, Japan
| |
Collapse
|
30
|
Oki R, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, Yamada D, Iwagami M, Doi K, Kume H, Nangaku M. Catheter Diversion Procedure With Exit-Site Renewal Promotes Peritoneal Dialysis Catheter Survival. Kidney Int Rep 2020; 6:325-332. [PMID: 33615057 PMCID: PMC7879110 DOI: 10.1016/j.ekir.2020.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/30/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Catheter-related infections such as exit site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) discontinuation. For ESI/TI treatment, catheter diversion procedure (CDP) with exit-site renewal for catheter salvage presents an alternative to catheter removal. Nevertheless, CDP capability of improving PD catheter survival remains unclear. Methods We retrospectively reviewed our hospital patients who started PD during 2001–2019 (n=148): 33 treated for ESI/TI by CDP (CDP group) and 115 treated for ESI/TI using conservative therapy or none (non-CDP group). A “virtual discontinuation group” was designated for patients in the CDP group who had received PD catheter removal instead of CDP and who had stopped PD. Kaplan-Meier analysis and log-rank test PD were used for intergroup catheter survival comparison. Associations between clinical factors and PD discontinuation or death were examined using Cox proportional hazards regression analyses. Results For patients (76% male, mean age of 61.7±13.0 years), 40 CDP were performed for 33 CDP group patients. Infection-free rates at 30 and 90 days after CDP were, respectively, 90% and 67%. The CDP group PD catheter survival rate was significantly higher than that of virtual discontinuation group (P < .01) and higher than that of the non-CDP group (P = .03). Multivariate analysis revealed independent association of serum albumin concentration (hazard ratio 0.33, 95% confidence interval 0.17–0.67), PD+HD combination therapy (hazard ratio 0.29, 95% confidence interval 0.17–0.49), and CDP (hazard ratio 0.44, 95% confidence interval 0.24–0.80) with PD discontinuation or death. Conclusion Results show that CDP may improve PD catheter survival as an effective and less-invasive surgical treatment for ESI/TI to avoid withdrawal of PD.
Collapse
Affiliation(s)
- Rikako Oki
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
- Correspondence: Yoshifumi Hamasaki, Department of Hemodialysis and Apheresis, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Yohei Komaru
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshihisa Miyamoto
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Ryo Matsuura
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, University of Tokyo Hospital, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tokyo, Japan
| | - Kent Doi
- Department of Acute Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, University of Tokyo Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
31
|
Higuchi C, Kuriyama J, Sakura H. Effect of lactate as a peritoneal dialysis fluid buffer on rat peritoneal mesothelial cells. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Neutral, low-glucose degradation product (GDP) peritoneal dialysis fluid (PDF) is less damaging to the peritoneum than conventional PDF but is still insufficient for biocompatibility. One remaining issue is the problem of buffering.
Methods
Using cultured rat peritoneal mesothelial cells (PMCs), the present study examined the difference between the effects of neutral low-GDP lactate PDF and neutral low-GDP bicarbonate/lactate PDF on cells. The effects of lactate stimulation on these cells were also examined.
Results
Lactate PDF enhanced mRNA expressions of α-smooth muscle actin (αSMA) and type 1 and type 3 collagens and lowered expression of e-cadherin mRNA in PMCs compared to bicarbonate/lactate PDF. Lactate stimulation increased mRNA expressions of αSMA, matrix metalloproteinase 2 (MMP2), and basic fibroblast growth factor (bFGF) and suppressed e-cadherin mRNA expression. Transforming growth factor (TGF)-β1 and TGF-β2 and collagen type 1 and 3 mRNA expressions were also enhanced by lactate stimulation.
Conclusions
These results suggest that lactate as a PDF buffer may act on PMCs to promote epithelial-mesenchymal transition (EMT) and production of TGF-β, bFGF, and collagen.
Collapse
|
32
|
Mizumasa T, Honda K, Aoki S, Hamada C, Miyazaki M, Ito Y, Tanno Y, Nakano T, Nakayama M. Proposal of peritoneal biopsy procedures for patients undergoing peritoneal dialysis. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-019-0254-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractProlonged peritoneal dialysis (PD) is responsible for progressive morphological changes such as deterioration of the peritoneal membrane. These changes increase the risk of encapsulating peritoneal sclerosis (EPS). Histological assessments of peritoneal membrane biopsy samples are fundamental for the evaluation of the peritoneal damage caused by PD. For evaluating serial morphological changes induced in the peritoneum by PD, we recommend to perform peritoneal biopsy examinations not only after the cessation of PD but also before performing PD. At the time of PD catheter insertion, the parietal peritoneum (1.5 × 1.5 cm) and rectus abdominal muscle posterior sheath is sampled at a point 3 cm below the PD catheter insertion site. Furthermore, at the time of PD catheter removal, the parietal peritoneum is sampled at a point 3 cm apart from the PD catheter insertion site to avoid artifacts. The peritoneum should be evaluated to detect mesothelial cell denudation, acellular sclerotic changes and thickness of the submesothelial connective tissue, vasculopathy of the post-capillary venules, vascular angiogenesis, and new encapsulating membrane. The method presented herein allows the minimization of surgical invasiveness and artifacts of the specimens and safe performance of peritoneal biopsy examinations. Morphological evaluation of the peritoneum involving an appropriate biopsy strategy, in conjunction with functional markers of deterioration, such as peritoneal permeability or cytokine levels, is a useful approach for examining peritoneal damage and predicting the prognosis of PD patients, especially the onset of EPS.
Collapse
|
33
|
Nakayama T, Uchiyama K, Washida N, Morimoto K, Muraoka K, Adachi K, Kasai T, Miyashita K, Wakino S, Itoh H. Exercise Parameters Predict Technique Survival in Patients on Peritoneal Dialysis. Blood Purif 2020; 50:380-389. [PMID: 33091919 DOI: 10.1159/000511293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The incremental shuttle walking test (ISWT) is an important marker of aerobic capacity in patients on peritoneal dialysis (PD). This study aimed to evaluate its predictive value for PD-related outcomes. METHODS This single-center cohort study recruited outpatients on maintenance PD from our hospital between March 2017 and March 2018. Exercise capacity was assessed using measurement of ISWT and handgrip and quadriceps strength. Patients were divided into 2 groups according to the median of exercise capacity and prospectively followed up until cessation of PD, death, or the study end (October 2019). The primary end point of this study was technique survival rate, and secondary outcomes were rates of peritonitis-free survival and PD-related hospitalization-free survival. RESULTS Among the 50 participants, age and PD vintage were [median (IQR)] 62.5 (58.3-70) and 3.5 (1.3-6.5) years, respectively. At the end of the study, 3 of the 28 participants (11%) in the long-ISWT group and 13 of the 22 participants (59%) in the short-ISWT group were transferred to hemodialysis. The short-ISWT group showed lower technique survival rate (p < 0.001), peritonitis-free survival rate (p = 0.01), and PD-related hospitalization-free survival rate (p < 0.01) than the long-ISWT group, whereas those survival rates did not differ when participants were divided by handgrip or quadriceps strength. Multivariate analysis revealed lower ISWT to be independently associated with technique failure (p = 0.002). CONCLUSION The ISWT is an important predictor of technique survival for patients on PD. Monitoring and enhancing ISWT as a marker of aerobic capacity might improve PD-related outcomes.
Collapse
Affiliation(s)
- Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan,
| | - Naoki Washida
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kohkichi Morimoto
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Keika Adachi
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Takahiro Kasai
- Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kazutoshi Miyashita
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Shu Wakino
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Hanamachi, Shinjuku-ku, Japan
| |
Collapse
|
34
|
Nakayama M, Hamada C, Yokoyama K, Tanno Y, Matsuo N, Nakata J, Ishibashi Y, Okuzawa A, Sakamoto K, Nara T, Kakuta T, Nangaku M, Yokoo T, Suzuki Y, Miyata T. A disposable, ultra-fine endoscope for non-invasive, close examination of the intraluminal surface of the peritoneal dialysis catheter and peritoneal cavity. Sci Rep 2020; 10:17565. [PMID: 33067481 PMCID: PMC7567793 DOI: 10.1038/s41598-020-74129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
The ability to visualize intraluminal surface of peritoneal dialysis (PD) catheter and peritoneal cavity could allow elucidation of the cases of outflow problems, and provide information on changes to the peritoneal membrane leading to encapsulating peritoneal sclerosis. A non-invasive examination that allows those monitoring in need is desirable. We have developed a disposable ultra-fine endoscope that can be inserted into the lumen of the existing PD catheter, allowing observation of the luminal side of the catheter and peritoneal cavity from the tip of the PD catheter, with minimum invasion in practice. In a pre-clinical study in pigs and a clinical study in 10 PD patients, the device provided detailed images, enabling safe, easy observation of the intraluminal side of the entire catheter, and of the morphology and status of the peritoneal surface in the abdominal cavity under dwelling PD solution. Since this device can be used repeatedly during PD therapy, clinical application of this device could contribute to improved management of clinical issues in current PD therapy, positioning PD as a safer, more reliable treatment modality for end-stage renal disease.
Collapse
Affiliation(s)
- Masaaki Nakayama
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Hongo 2-1-1, Tokyo, 113-8421, Japan. .,United Centers for Advanced Research and Translational Medicine (ART), Tohoku University Graduate School of Medicine, Sendai, Japan. .,Kidney Center, St Luke's International Hospital, Tokyo, Japan.
| | - Chieko Hamada
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nanae Matsuo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Junichiro Nakata
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshio Ishibashi
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Atsushi Okuzawa
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tamaki Nara
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Hongo 2-1-1, Tokyo, 113-8421, Japan
| | - Takatoshi Kakuta
- Division of Nephrology and Metabolism, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Miyata
- United Centers for Advanced Research and Translational Medicine (ART), Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
35
|
Successful treatment with assisted automated peritoneal dialysis using 4.25% glucose dialysate for an elderly patient with refractory heart failure. CEN Case Rep 2020; 10:121-125. [PMID: 32930999 DOI: 10.1007/s13730-020-00533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022] Open
Abstract
Refractory heart failure is a major cause of mortality and hospitalization, and peritoneal dialysis (PD) is one of the options for controlling volume overload. Although high glucose dialysate enables a large amount of ultrafiltration, the use of 4.25% glucose dialysate is generally avoided, because high glucose exposure leads to peritoneal damage. Here, we describe a patient who was successfully treated with assisted automated PD using 4.25% glucose dialysate for refractory heart failure. An 84-year-old woman developed heart failure due to severe mitral regurgitation with a low left-ventricular ejection fraction of 30%, and also developed progressive kidney deterioration. She had been refractory to diuretics and repeatedly hospitalized. PD was started to treat refractory heart failure. Since it was difficult for her to change the dialysis bags by herself, assistance with her PD from her family was needed. The use of 4.25% glucose dialysate markedly increased ultrafiltration and improved her condition. In addition, automated PD (APD) using 4.25% glucose dialysate enabled her family to have a break from PD once every 4 days. Thereafter, she had no episodes of hospitalization due to heart failure for approximately 18 months after her discharge.
Collapse
|
36
|
Konishi T, Fujiogi M, Michihata N, Morita K, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Treatments and outcomes of encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis: 295 cases from a nationwide inpatient database in Japan. Perit Dial Int 2020; 40:593-599. [PMID: 32519585 DOI: 10.1177/0896860820930635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The number of patients undergoing renal replacement therapy is increasing. We evaluated the practice patterns and outcomes of encapsulating peritoneal sclerosis (EPS) in patients undergoing peritoneal dialysis. METHODS Using a Japanese national inpatient database, we identified 295 patients with EPS who were hospitalized from July 2010 to March 2017. We categorized them into four groups: those who underwent surgery only (n = 39), those who received corticosteroid treatment only (n = 70), those who underwent both (n = 30), and those who underwent neither (n = 156). We investigated their characteristics, treatments, and outcomes. RESULTS More than half of patients were males and never-smokers and had a normal body mass index. Patients tended to undergo parenteral nutrition for 2 months. The proportions of emergency admission, intensive care unit (ICU) admission, central venous catheterization, catecholamine use, mechanical ventilation, and continuous hemodiafiltration were significantly different among the four groups (61%, 8.1%, 37.0%, 44.0%, 8.8%, and 5.8%, respectively). The both-treatment group had a significantly longer hospital stay (37.0 vs. 37.5 vs. 72.5 vs. 31.0 days, p < 0.001) and higher costs (US$16,554 vs. US$17,029 vs. US$33,757 vs. US$13,983, p < 0.001) than the other groups. In total, 52 patients (18%) died during hospitalization. There was no significant difference in inhospital complications and death, discharge status, 30-day readmission, or length of ICU stay among the four groups. CONCLUSIONS Our findings provide useful information for clinicians and patients hospitalized for treatment of EPS.
Collapse
Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, 13143The University of Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, 13143The University of Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, 13143The University of Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, 13143The University of Tokyo, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, 13143The University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, 13143The University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, 13143Tokyo Medical and Dental University Graduate School, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, 13143The University of Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, 13143The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, 13143The University of Tokyo, Japan
| |
Collapse
|
37
|
Tanaka M, Ishibashi Y, Hamasaki Y, Kamijo Y, Idei M, Nishi T, Takeda M, Nonaka H, Nangaku M, Mise N. Ultrafiltration volume by once-weekly hemodialysis is a predictor of technique survival of combination therapy with peritoneal dialysis and hemodialysis. Ther Apher Dial 2020; 25:82-87. [PMID: 32383342 DOI: 10.1111/1744-9987.13509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/13/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Overhydration is a major cause of technique failure of peritoneal dialysis (PD). Hence, we investigated the impact of ultrafiltration (UF) volume by once-weekly hemodialysis (HD), excess volume beyond their dry weight, on technique survival of PD and HD combination therapy (PD+HD). Forty-six anuric PD+HD patients were divided into three groups according to baseline UF volume by HD: low-UF (<mean - 1SD), middle-UF (≥mean - 1SD and <mean + 1SD), and high-UF (≥mean + 1SD). High-UF group showed larger extracellular water normalized to height (P = .038) and longer HD sessions (P < .001) compared with low-UF group, whereas low-UF group was older than middle-UF group (P = .001). Technique survival rate was significantly lower in high-UF group than in low and middle-UF groups (P < .001), and the rates at 44 months were 80%, 90%, 20% in low, middle, and high-UF groups, respectively. Chronic overhydration was the leading cause of technique failure for all. This study suggests that fluid overload remains a major cause of technique failure of PD even after once-weekly HD is added.
Collapse
Affiliation(s)
- Mototsugu Tanaka
- Division of Nephrology and Endocrinology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Yoshitaka Ishibashi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Division of Nephrology and Endocrinology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Yuka Kamijo
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mayumi Idei
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | | | | | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Naobumi Mise
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| |
Collapse
|
38
|
Tawada M, Ito Y, Banshodani M, Yamashita M, Shintaku S, Sun T, Suzuki Y, Kinashi H, Kubo Y, Ando M, Yamaguchi M, Katsuno T, Mizuno M, Kawanishi H. Vasculopathy plays an important role during the development and relapse of encapsulating peritoneal sclerosis with conventional peritoneal dialysis solutions. Nephrol Dial Transplant 2020; 36:1519-1526. [DOI: 10.1093/ndt/gfaa073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Encapsulating peritoneal sclerosis (EPS) is an uncommon but life-threatening complication of peritoneal dialysis (PD) therapy. The causative factors of EPS remain unclear. Pathological studies of the peritoneum affected by EPS and relationships with clinical factors including PD solutions remain lacking. The objective of this study was to examine peritoneal samples from EPS patients and to identify the associations of peritoneal pathology with different clinical factors.
Methods
Peritoneal specimens were obtained at the time of surgical enterolysis in Tsuchiya General Hospital from 1993 to 2016. A total of 223 PD patients were enrolled and analyzed. Tissues were fixed with formalin and processed with hematoxylin and eosin and Masson’s trichrome staining, as well as immunohistochemical staining for CD31 and CD68.
Results
Evaluations could be made in 174 patients who received surgical enterolysis. Conventional or pH-neutral low-glucose degradation product PD solutions were utilized during PD treatment. The conventional PD solution group showed less angiogenesis (P = 0.013) but more severe vasculopathy, in the form of a lower ratio of luminal diameter to vessel diameter (L/V ratio) (P < 0.001) in association with longer PD treatment. Multivariate Cox proportional hazard models revealed that L/V ratio (per 0.1 increase, hazard ratio = 0.88, 95% confidence interval 0.77–0.99, P = 0.047) was significantly associated with a lower incidence of EPS relapse. In contrast, most of the cases in the pH-neutral solution group showed milder vasculopathy.
Conclusions
The pathology of EPS differed between conventional and pH-neutral solution groups. Vasculopathy was related to the development and relapse of EPS in the conventional solution group.
Collapse
Affiliation(s)
- Mitsuhiro Tawada
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masataka Banshodani
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Masahiro Yamashita
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Sadanori Shintaku
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Ting Sun
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masashi Mizuno
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Kawanishi
- Department of Surgery and Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| |
Collapse
|
39
|
Lambie M, Teece L, Johnson DW, Petrie M, Mactier R, Solis-Trapala I, Belcher J, Bekker HL, Wilkie M, Tupling K, Phillips-Darby L, Davies SJ. Estimating risk of encapsulating peritoneal sclerosis accounting for the competing risk of death. Nephrol Dial Transplant 2020; 34:1585-1591. [PMID: 30820552 PMCID: PMC6735880 DOI: 10.1093/ndt/gfz034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Indexed: 02/06/2023] Open
Abstract
Background Risk of encapsulating peritoneal sclerosis (EPS) is strongly associated with the duration of peritoneal dialysis (PD), such that patients who have been on PD for some time may consider elective transfer to haemodialysis to mitigate the risk of EPS. There is a need to determine this risk to better inform clinical decision making, but previous studies have not allowed for the competing risk of death. Methods This study included new adult PD patients in Australia and New Zealand (ANZ; 1990–2010) or Scotland (2000–08) followed until 2012. Age, time on PD, primary renal disease, gender, data set and diabetic status were evaluated as predictors at the start of PD, then at 3 and 5 years after starting PD using flexible parametric competing risks models. Results In 17 396 patients (16 162 ANZ, 1234 Scotland), EPS was observed in 99 (0.57%) patients, less frequently in ANZ patients (n = 65; 0.4%) than in Scottish patients (n = 34; 2.8%). The estimated risk of EPS was much lower when the competing risk of death was taken into account (1 Kaplan–Meier = 0.0126, cumulative incidence function = 0.0054). Strong predictors of EPS included age, primary renal disease and time on PD. The risk of EPS was reasonably discriminated at the start of PD (C-statistic = 0.74–0.79) and this improved at 3 and 5 years after starting PD (C-statistic = 0.81–0.92). Conclusions EPS risk estimates are lower when calculated using competing risk of death analyses. A patient’s estimated risk of EPS is country-specific and can be predicted using age, primary renal disease and duration of PD.
Collapse
Affiliation(s)
- Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Staffordshire, UK
| | - Lucy Teece
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| | - Michaela Petrie
- Renal Unit, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh, Scotland, UK
| | - Robert Mactier
- Renal Services, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Ivonne Solis-Trapala
- Institute for Applied Clinical Sciences, Keele University, Staffordshire, UK.,Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - John Belcher
- Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martin Wilkie
- Renal Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ken Tupling
- Kidney Patient Association, Sheffield Area Kidney Association, Northern General Hospital, Sheffield, UK
| | | | - Simon J Davies
- Institute for Applied Clinical Sciences, Keele University, Staffordshire, UK
| |
Collapse
|
40
|
Obata Y, Murashima M, Toda N, Yamamoto S, Tsujimoto Y, Tsujimoto Y, Tsujimoto H, Yuasa H, Ryuzaki M, Ito Y, Tomo T, Nakamoto H. Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00261-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The International Society for Peritoneal Dialysis guidelines recommends the topical application of antibiotics on the exit site for the prevention of peritoneal dialysis (PD)-related infections. However, the recommendation is based on meta-analyses on applying nasal mupirocin ointment or observational or retrospective studies. Here, we evaluated the efficacy of topical application of mupirocin on the exit site for the prevention of PD-related infections.
Methods
We searched the databases, MEDLINE and CENTRAL, documenting the topical application of antibiotics on the exit site in PD patients in April 2017. We included only randomized controlled trials (RCTs) with adult patients wherein the effects of mupirocin were examined. Exit site infection (ESI), peritonitis, and technical failure were assessed as the main outcomes.
Results
Overall, six RCTs were included in this study. It was uncertain whether the application of mupirocin ointment prevents ESI (rate ratio (RR), 0.36; 95% CI, 0.13–1.05), peritonitis (RR 0.78, 95% CI 0.50–1.21), and technical failure (RR, 1.35; 95% CI, 0.25–7.21). Moreover, a comparison between mupirocin and gentamicin showed no difference in the incidence of ESI (RR, 1.14; 95% CI, 0.27–4.81), peritonitis (RR, 0.85; 95% CI, 0.32–2.26), and technical failure (RR, 0.58; 95% CI, 0.28–1.20).
Conclusions
It remains unclear whether topical application of mupirocin on the exit site has any significant effects on PD-related infection or technical failure. Large-scale RCTs with high methodological quality are required to confirm the efficacy of topical application of antibiotics on the exit site.
Trial registration
UMINR000039267
Collapse
|
41
|
Gyotoku H, Azuma Y, Furuzono T. Evaluation of fluorinated hydroxyapatite nanoparticles as an antibacterial material for catheter coating. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-019-0251-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundCatheter-related infection of peritoneal dialysis (PD) is one of the serious factors of peritonitis. However, an antibacterial PD catheter has not been commercially available in Japan yet. From an infection control viewpoint, it is necessary to develop an antibacterial coating material for catheters with a long-term effectiveness.MethodsFluorinated hydroxyapatite (F-HAp) nanoparticles were prepared by a wet chemical process. F-HAps with different F substitution contents were prepared by adjusting the feed ratio of F ions versus sites of OH groups in HAp structures. The characterization and evaluation of F-HAps were conducted using several analytical equipment and an antibacterial powder assay.ResultsThe F-HAp nanoparticles possessed highly crystalline and dispersibility. The F-HAps were named as F(30)-HAp, F(50)-HAp, and F(100)-HAp and were 24, 52, and 84% of the actual F substitution content, respectively. The nanomaterials showed acidic resistance, i.e., chemical stability, compared to normal HAp. In an antibacterial assay of F(100)-HAp with 50 mg in 0.2 mL of NaCl aqueous solution, four types of causative bacteria of catheter-related infections,Pseudomonas aeruginosa,Staphylococcus aureus,Enterobacter aerogenes, andKlebsiella pneumoniaewere used. The antibacterial activities of F(100)-HAp showed 50–60% against the microorganisms. F ions were gradually released and finally plateaued at 24 weeks.ConclusionsThe retention possibility of the antibacterial effect of F(100)-HAp potentially lasted for 24 weeks based on the F ions release behavior. It is expected that the antibacterial performance can be improved by the precise control of material engineering technology, although the duration of the effect has not yet been satisfactory for a PD catheter.
Collapse
|
42
|
Ryu JH, Lee KY, Koo TY, Kim DK, Oh KH, Yang J, Park KJ. Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea. Kidney Res Clin Pract 2019; 38:499-508. [PMID: 31640301 PMCID: PMC6913596 DOI: 10.23876/j.krcp.19.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established. Methods We retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation. Results Thirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months. Conclusion The high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.
Collapse
Affiliation(s)
- Jung-Hwa Ryu
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kil-Yong Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tai Yeon Koo
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
43
|
Chen YT, Hsu H, Lin CC, Pan SY, Liu SY, Wu CF, Tsai PZ, Liao CT, Cheng HT, Chiang WC, Chen YM, Chu TS, Lin SL. Inflammatory macrophages switch to CCL17-expressing phenotype and promote peritoneal fibrosis. J Pathol 2019; 250:55-66. [PMID: 31579932 DOI: 10.1002/path.5350] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022]
Abstract
Peritoneal fibrosis remains a problem in kidney failure patients treated with peritoneal dialysis. Severe peritoneal fibrosis with encapsulation or encapsulating peritoneal sclerosis is devastating and life-threatening. Although submesothelial fibroblasts as the major precursor of scar-producing myofibroblasts in animal models and M2 macrophage (Mϕ)-derived chemokines in peritoneal effluents of patients before diagnosis of encapsulating peritoneal sclerosis have been identified, attenuation of peritoneal fibrosis is an unmet medical need partly because the mechanism for cross talk between Mϕs and fibroblasts remains unclear. We use a sodium hypochlorite-induced mouse model akin to clinical encapsulated peritoneal sclerosis to study how the peritoneal Mϕs activate fibroblasts and fibrosis. Sodium hypochlorite induces the disappearance of CD11bhigh F4/80high resident Mϕs but accumulation of CD11bint F4/80int inflammatory Mϕs (InfMϕs) through recruiting blood monocytes and activating local cell proliferation. InfMϕs switch to express chemokine (C-C motif) ligand 17 (CCL17), CCL22, and arginase-1 from day 2 after hypochlorite injury. More than 75% of InfMϕs undergo genetic recombination by Csf1r-driven Cre recombinase, providing the possibility to reduce myofibroblasts and fibrosis by diphtheria toxin-induced Mϕ ablation from day 2 after injury. Furthermore, administration of antibody against CCL17 can reduce Mϕs, myofibroblasts, fibrosis, and improve peritoneal function after injury. Mechanistically, CCL17 stimulates migration and collagen production of submesothelial fibroblasts in culture. By breeding mice that are induced to express red fluorescent protein in Mϕs and green fluorescence protein (GFP) in Col1a1-expressing cells, we confirmed that Mϕs do not produce collagen in peritoneum before and after injury. However, small numbers of fibrocytes are found in fibrotic peritoneum of chimeric mice with bone marrow from Col1a1-GFP reporter mice, but they do not contribute to myofibroblasts. These data demonstrate that InfMϕs switch to pro-fibrotic phenotype and activate peritoneal fibroblasts through CCL17 after injury. CCL17 blockade in patients with peritoneal fibrosis may provide a novel therapy. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Yi-Ting Chen
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.,Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hao Hsu
- Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Chun Lin
- Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Yu Pan
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Renal Division, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shin-Yun Liu
- Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Fang Wu
- Department of Internal Medicine, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Pei-Zhen Tsai
- Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Te Liao
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Hui-Teng Cheng
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Wen-Chih Chiang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzong-Shinn Chu
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuei-Liong Lin
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.,Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
44
|
Jagirdar RM, Bozikas A, Zarogiannis SG, Bartosova M, Schmitt CP, Liakopoulos V. Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options. Int J Mol Sci 2019; 20:ijms20225765. [PMID: 31744097 PMCID: PMC6887950 DOI: 10.3390/ijms20225765] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.
Collapse
Affiliation(s)
- Rajesh M. Jagirdar
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Andreas Bozikas
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
| | - Sotirios G. Zarogiannis
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
- Department of Physiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.G.Z.); (M.B.); (C.P.S.)
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (R.M.J.); (A.B.)
- Correspondence: ; Tel.: +30-2310-994694
| |
Collapse
|
45
|
Kawanishi H, Banshodani M, Yamashita M, Shintaku S, Dohi K. Surgical Treatment for Encapsulating Peritoneal Sclerosis: 24 Years’ Experience. Perit Dial Int 2019; 39:169-174. [DOI: 10.3747/pdi.2018.00042] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/17/2018] [Indexed: 12/16/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis. The mortality rate for EPS is high, primarily due to complications related to bowel obstruction. Surgery was previously contraindicated; however, surgical enterolysis is performed for patients in whom bowel obstruction fails to improve. Methods This was a retrospective observational study of patients with EPS who received surgical intervention at a single center between November 1993 and October 2017. The severity of intestine damage was characterized by grade-3 peritoneal calcification on abdominal computed tomography (CT) scan and degeneration of the small intestinal wall in surgery. Results Two-hundred and forty-three patients with EPS opted for surgery. Among them, 58 had recurrence and required re-surgery; a total of 318 EPS surgeries were performed. Death was related to EPS in 61 patients (25.1%), of whom 15 died postoperatively. Sixty-seven patients (27.6%) died from other causes. The actuarial survival rates at 1, 2, 3, 5, and 8 years after EPS diagnosis were 91%, 83%, 77%, 66%, and 53% respectively. The 50% actuarial survival points after EPS diagnosis and surgery were 104 months and 85 months, respectively. Peritoneal calcification and small intestinal wall degeneration grading showed significant association with the mortality curve for EPS-related death. Conclusion Excellent outcomes for EPS are achieved with surgery. The degree of peritoneal deterioration affected the clinical outcomes. Currently, EPS is no longer recognized as a fatal complication.
Collapse
Affiliation(s)
- Hideki Kawanishi
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
- Faculty of Medicine, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Masataka Banshodani
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Masahiro Yamashita
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Sadanori Shintaku
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Kiyohiko Dohi
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
- Faculty of Medicine, Hiroshima University, Minami-ku, Hiroshima, Japan
| |
Collapse
|
46
|
Tawada M, Hamada C, Suzuki Y, Sakata F, Sun T, Kinashi H, Katsuno T, Takei Y, Maruyama S, Honda K, Mizuno M, Ito Y. Effects of long-term treatment with low-GDP, pH-neutral solutions on peritoneal membranes in peritoneal dialysis patients. Clin Exp Nephrol 2018; 23:689-699. [DOI: 10.1007/s10157-018-1679-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/04/2018] [Indexed: 01/08/2023]
|
47
|
Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8250589. [PMID: 30539021 PMCID: PMC6258094 DOI: 10.1155/2018/8250589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/14/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022]
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a rare but serious clinical complication of long-term peritoneal dialysis (PD) patients with high mortality. The purpose of this study was to assess the clinical characteristics of patients with EPS and to search for possible factors useful for EPS prevention and early diagnosis. Method This retrospective study was performed in a single dialysis center in Taiwan between August 1990 and April 2014. Overall, a total of 565 patients were included and the medical records of those patients who had developed EPS (EPS group) and those who had not developed EPS (control group) were collected. We compared several factors between these two groups. Result In the univariate analysis, EPS was significantly associated with a change of transport state (Delta 2) (p = 0.007), duration of PD (p < 0.001), duration of peritonitis treatment (p = 0.001), number of peritonitis episodes (p = 0.002), and fungus related peritonitis (p = 0.031). After multivariate logistic model analysis, we found that only the duration of PD was independently significantly associated with EPS (p = 0.034). In addition, we used the ROC curve and found that a duration of peritoneal dialysis of about 8.4 years is the best cut-off point to predict EPS occurrence. Conclusion In this study, long-termed PD duration is the only strong independent risk factor for EPS development. Total peritonitis times, total peritonitis treatment duration, and marked increased peritoneal D/Pcr ratio were also significantly associated with the duration of PD.
Collapse
|
48
|
Oka H, Yamada S, Kamimura T, Aihara S, Hyodo M, Terakado N, Harada A, Nakano T, Tsuruya K, Kitazono T. Better Oral Hygiene Habits Are Associated With a Lower Incidence of Peritoneal Dialysis‐Related Peritonitis. Ther Apher Dial 2018; 23:187-194. [DOI: 10.1111/1744-9987.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Hideaki Oka
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Taro Kamimura
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
| | - Seishi Aihara
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Masahide Hyodo
- Department of Dentistry and Oral SurgeryMatsuyama Red Cross Hospital Matsuyama Japan
| | - Nagaaki Terakado
- Department of Dentistry and Oral SurgeryMatsuyama Red Cross Hospital Matsuyama Japan
| | - Atsumi Harada
- Division of Kidney CenterMatsuyama Red Cross Hospital Matsuyama Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu University Fukuoka Japan
| |
Collapse
|
49
|
Danford CJ, Lin SC, Smith MP, Wolf JL. Encapsulating peritoneal sclerosis. World J Gastroenterol 2018; 24:3101-3111. [PMID: 30065556 PMCID: PMC6064970 DOI: 10.3748/wjg.v24.i28.3101] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/07/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents (i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPS-specific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is time-consuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.
Collapse
Affiliation(s)
- Christopher J Danford
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Steven C Lin
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Martin P Smith
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Jacqueline L Wolf
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| |
Collapse
|
50
|
Dioos B, Paternot G, Jenvert RM, Duponchelle A, Marshall MR, Nakajima M, Ramirez Ganoza E, Sloand JA, Wieslander AP. Biocompatibility of a new PD solution for Japan, Reguneal™, measured as in vitro proliferation of fibroblasts. Clin Exp Nephrol 2018; 22:1427-1436. [PMID: 29926312 DOI: 10.1007/s10157-018-1602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate in vitro biocompatibility of Reguneal™, a new bicarbonate containing peritoneal dialysis fluid (PDF) for Japan, and compare it with other PDFs available in that country. METHODS We assessed basal cytotoxicity using in vitro proliferation of cultured fibroblasts, L-929, determining the quantity of living cells by the uptake of Neutral Red. Levels of ten glucose degradation products (GDPs) were measured by a validated ultrahigh-performance liquid chromatography method in combination with an ultraviolet detector. We compared inhibition of fibroblast cell growth between brands of PDF, adjusting for dextrose and GDP concentrations using random-effects mixed models. RESULTS The results demonstrate that cytotoxicity of Reguneal™ is comparable to a sterile-filtered control and is less cytotoxic than most of the other PDFs, most of which significantly inhibited cell growth. As a "class effect", increasing dextrose and GDP concentrations were non-significantly but positively associated with cytotoxicity. As a "brand effect", these relationships varied widely between brands, and some PDFs had significant residual effects on basal cytotoxicity through mechanisms that were unassociated with either dextrose or GDP concentration. CONCLUSION Our study suggests that Reguneal™ is a biocompatible PDF. The results of our study also highlight that dextrose and GDPs are important for biocompatibility, but alone are not a complete surrogate. The results of our study need to be confirmed in other tissue culture models, and should lead to further research on determinants of biocompatibility and the effect of such PDFs on clinical outcomes.
Collapse
Affiliation(s)
- Bart Dioos
- Baxter Research and Development (Europe), Braine-l'Alleud, Belgium
| | - Goedele Paternot
- Baxter Research and Development (Europe), Braine-l'Alleud, Belgium
| | | | | | | | | | | | | | | |
Collapse
|