Abstract: TH-PO858

Peritoneal Membrane Morphology Following Peritonitis in Low GDP Peritoneal Dialysis

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Schaefer, Betti, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
  • Schmitt, Claus P., Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
  • Bartosova, Maria, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
  • Ujszaszi, Akos, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
  • Ranchin, Bruno, Pediatrics, Lyon, France
  • Vondrak, Karel, University Hospital Prague-Motol, Prague 5, Czechia
  • Ariceta, Gema, Hospital Universitari Vall d' Hebron, Barcelona, Spain
  • Zaloszyc, Ariane, Strasbourg''s Hospital University, Strasbourg, France
  • Schaefer, Franz S., University of Heidelberg, Heidelberg, BW, Germany
  • Warady, Bradley A., The Children's Mercy Hospital, Kansas City, Missouri, United States

Group or Team Name

  • International Pediatric Peritoneal Biopsy Study Group
Background

Long term impact of peritonitis on peritoneal membrane integrity and function is incompletely understood. Whereas experimental studies suggest a major impact of peritonitis, respective human data is scant. Children are uniquely suited for analyses of specific PD related effects, since they are devoid of preexisting tissue changes.

Methods

Within the scope of the International Pediatric Peritoneal Biopsy Study we obtained 94 standardized peritoneal specimens from children on low GDP PD for automated quantitative morphometric and molecular tissue analyses. Ten patients who had acute peritonitis less than 4 weeks before biopsy sampling were excluded from the analysis.

Results

37/84 children had a history of peritonitis and 16/37 had 2 or more episodes of peritonitis. Median age at biopsy was 6.2 (2.6, 13.2) years, 46% girls, and median PD vintage was 15.0 (8.5, 32.9) months. The 37 patients who previously suffered from peritonitis did not differ in anthropometrical parameters from those without peritonitis. Patients with peritonitis were on PD longer (21.0 (12.0, 36.0) v. 12.8 (7.3, 27.0) months; p=0.053). The mesothelial cell layer integrity and the submesothelial zone thickness were similar in both groups. There was no difference in median capillary density, lymphatic capillary density or in the endothelial surface area. Lymphatic vessel density remained low in both groups. Lumen / Vessel ratio as a marker of vasculopathy was also comparable in both groups. ASMA+ activated fibroblasts (59% v. 47%; p=0.27), CD45+ lymphocytes (65% v. 66%; p=0.97) and CD68+ macrophages (60% v. 70%; p=0.18) had a similar prevalence. There were no alterations in fibrin deposits or the degree of Epithelial-Mesenchymal Transition (EMT). In a sensitivity analysis where 24 (total 48) patients were matched for age and PD duration, we did not find any significant differences.

Conclusion

Peritonitis is a common complication of PD. The impact on peritoneal membrane integrity, however, is low. Non-acute post peritonitis peritoneal membrane morphology does not differ with regard to inflammation, EMT, fibrosis and vessel density as compared to children without a history of peritonitis.