Renal hyperparathyroidism- a risk factor in the development of encapsulating peritoneal sclerosis

Background

Encapsulating peritoneal sclerosis (EPS) is a rare complication of prolonged peritoneal dialysis (PD) exposure, characterised by peritoneal thickening, calcification, and fibrosis ultimately presenting with life-threatening bowel obstruction. The presence or role of peritoneal calcification in the pathogenesis of EPS is poorly characterised. We hypothesise that significantly aberrant bone mineral metabolism in patients on PD can cause peritoneal calcification which may trigger the development of EPS. We compared the temporal evolution of bone mineral markers during PD in EPS patients with non-EPS long-term PD controls.

Methods

Linear mixed model and logistic regression analysis were used to compare four-monthly serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase (ALP) over the duration of PD exposure in 46 EPS and 46 controls (PD, non-EPS) patients.

Results

EPS patients had higher mean calcium (2.51 vs. 2.41 mmol/L) and ALP (248.00 vs. 111.13 IU/L) levels compared with controls (p=0.01 and p<0.001 respectively, maximum likelihood estimation). Logistic regression analysis demonstrated that high serum calcium and phosphate levels during PD were associated with a 4.5 and 2.9 fold increase in the risk of developing EPS respectively.

Conclusion

High levels of calcium and phosphate in patients on PD were identified to be risk factors for EPS development. Possible reasons for this may be an imbalance of pro-calcifying factors and calcification inhibitors promoting peritoneal calcification which increases peritoneal stiffness. Mechanical alterations may trigger, unregulated fibrosis and subsequent development of EPS. Improved management of secondary hyperparathyroidism during PD may ultimately diminish the EPS risk.

Comparison between Antimicrobial and Antibiofilm Activity of Exopolysaccharides (EPS) Extracted from Lactobacillus reuteri and Streptococcus mitis against Oral Bacteria

Due to the increased resistance to antibiotics and chemical biocides, the use of bacterial exopolysaccharides has been considered. The objective of the current study was to investigate the strength of the antibacterial and antibiofilm activity of EPS extracted from Lactobacillus reuteri and Streptococcus mitis because previous studies showed there were structural differences between EPS, during this study, EPS extracted from Lactobacillus reuteri and Streptococcus miti by ethanol precipitation method and estimated antibacterial and antibiofilm activity against several Oral Bacteria (Staphylococcus aureus, Staphylococcus hominis, Acinetobacter baumannii, Raoultella ornithinolytica, Streptococcus thoraltensis in different concentration as (100,150,200,250,300 mg/ml ), the results showed carbohydrates rate in extracted EPS from L. reuteri and S. mitis were recorded was 85, 80 % respectively.The concentration 100 and 150 mg/ml for EPS from L. reuteri and S. mitis, there was no inhibitory effect, except in S. aureus (1.1±0.10) and S. hominis (1.0±0.10) at 100 mg/ml, 3.1±2.01, 2.1±0.54 mg/ml respectively at 150 mg/ml concentration but no significant differences (P≤0.05). However, the antibacterial effect of that EPSs started at the concentration of 200 and upwards, where different results were recorded between the concentrations of both EPSs against all bacteria isolated (P≤0.05), On the other hand, the effect of EPS from L. reuteri and S. mitis was clear against the formation of biofilm compared with the control, worth mentioning that EPS from L. reuteri was more effective compared with EPS from S. mitis in all isolates (P≤0.05) except for S. thoraltensis where it was noted that the EPS from S. mitis is more effective than EPS from L. reuteri. Through the results obtained in this study, it was noted that the difference in the structural nature of EPS has an important role in its effectiveness as an antibacterial and anti-biofilm formation and, as it was found that the EPS from L. reuteri showed more effectiveness than EPS from S. mitis and thus the mechanism of preventing and inhibiting bacteria depending of the structural nature of EPS.