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Kidney Week

Abstract: PO0987

Cumulative Dialysate Glucose Exposure Is a Risk Factor for Peritoneal Sclerosis in Pediatric Peritoneal Dialysis Patients Using Neutral-pH Fluids

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Shirai, Yoko, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
  • Miura, Kenichiro, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
  • Ando, Taro, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
  • Shiratori, Atsutoshi, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
  • Kaneko, Naoto, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
  • Ishizuka, Kiyonobu, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
  • Taneda, Sekiko, Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
  • Hirano, Daishi, Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
  • Yamaguchi, Yutaka, Yamaguchi Pathology Laboratory, Chiba, Japan
  • Honda, Kazuho, Department of Anatomy, Showa University School of Medicine, Tokyo, Japan
  • Hattori, Motoshi, Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
Background

The benefits of neutral-pH fluids for preventing peritoneal dialysis (PD)-related peritoneal sclerosis have been established, however, advanced peritoneal sclerosis still has been described in pediatric PD patients using neutral-pH fluids (Kidney Int 2018). The factors associated with peritoneal pathological changes after long-term use of neutral-pH fluids have not been elucidated.

Methods

Pediatric PD patients using only conventional acidic fluids (conventional group, n=31) and those using only neutral-pH fluids (neutral-pH group, n=33) for more than one year were analyzed. Propensity score matching was performed to compare the peritoneal pathological changes between groups. Clinical risk factors including PD duration and cumulative dialysate glucose exposure for peritoneal pathological changes in the neutral-pH group were analyzed using generalized linear model. Furthermore, immunofluorescence studies were performed on vascular endothelial growth factor-α (VEGF-α), cytokeratin; an epithelial marker, and α-smooth muscle actin (α-SMA); a myofibroblastic marker of epithelial-mesenchymal transition (EMT).

Results

Age at biopsy was 11.5 [8-17] years (median [IQR]) and duration of dialysis was 3.2 [1.7-5.3] years. The neutral-pH group showed less peritoneal deterioration except for higher submesothelial microvessel density (P <0.01) than conventional group. In the neutral-pH group, the cumulative dialysate glucose exposure was an independent risk factor for increased thickness of the submesothelial compact zone [OR, 1.004; 95%CI, 1.001, 1.007] and submesothelial microvessel density [OR, 1.003; 95%CI, 1.000-1.005]. Cumulative dialysate glucose exposure correlated with the proportion of VEGF-α positive areas (P<0.01, r=0.55). In immunofluorescence study, VEGF-α (+) cells comprised cytokeratin (+) cells and α-SMA (+) cells.

Conclusion

The neutral-pH fluids showed less deteriorations of the peritoneal membrane than acidic fluids except for increased angiogenesis. Cumulative dialysate glucose exposure was an independent risk factor for peritoneal fibrosis and angiogenesis in pediatric patients using neutral-pH fluids, which might be associated with increased VEGF-α production by mesothelial cells presenting EMT.