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Kidney Week

Abstract: SA-PO678

Peritoneal Endothelial Hyaluronan in Glycocalyx Is Decreased in Peritoneal Dialysis Patients Treated with Conventional Solutions

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Kamiya, Keisuke, Aichi Ika Daigaku, Nagakute, Aichi, Japan
  • Tawada, Mitsuhiro, Nagoya Daigaku, Nagoya, Aichi, Japan
  • Asai, Akimasa, Aichi Ika Daigaku, Nagakute, Aichi, Japan
  • Kinashi, Hiroshi, Aichi Ika Daigaku, Nagakute, Aichi, Japan
  • Yamaguchi, Makoto, Aichi Ika Daigaku, Nagakute, Aichi, Japan
  • Mizuno, Masashi, Nagoya Daigaku, Nagoya, Aichi, Japan
  • Banshodani, Masataka, Tsuchiya Sogo Byoin, Hiroshima, Japan
  • Ishimoto, Takuji, Aichi Ika Daigaku, Nagakute, Aichi, Japan
  • Kawanishi, Hideki, Tsuchiya Sogo Byoin, Hiroshima, Japan
  • Ito, Yasuhiko, Aichi Ika Daigaku, Nagakute, Aichi, Japan
Background

Peritoneal membrane dysfunction in peritoneal dialysis (PD) is primarily attributed to angiogenesis; however, the integrity of vascular endothelial cells can affect peritoneal permeability. Glycocalyx is a bioactive gel-like layer and is known to play roles in maintaining a negative charge, regulating coagulation, and controlling microvascular permeability. Degradation of glomerular hyaluronan, a component of the endothelial glycocalyx, leads to proteinuria and structural damage. One hypothesis suggests that development of encapsulating peritoneal sclerosis (EPS) is triggered by protein leakage due to vascular endothelial injury. We therefore investigated the expression of hyaluronan of glycocalyx in peritoneal membrane of normal and diseased conditions.

Methods

We studied the expression of hyaluronan in a total of 254 peritoneal membrane tissues of PD patients and chlorhexidine-induced peritonitis model. Five healthy donors of kidney transplants were used as control. Peritoneal hyaluronan expression was visualized using biotin-labeled human hyaluronan-binding protein (HABP). CD31, CD68 and ratio of luminal diameter to vessel diameter (L/V ratio) were also evaluated.

Results

Hyaluronan expression was much lower in the PD patients undergoing long-term PD treatment with conventional solution than those treated with low-GDP, pH-neutral solutions (p<0.001). There were no significant differences in the number of vessels or macrophages between the groups. In EPS cases, L/V ratio and hyaluronan expression significantly decreased in those treated with conventional solutions. The extent of hyaluronan loss correlated with the severity of vasculopathy (r2=0.524, p<0.0001). Hyaluronan expression in EPS patients treated with conventional solutions declined even though the L/V ratio was relatively high. In peritonitis of human and animal model, hyaluronan expression were preserved in spite of the inflammatory conditions.

Conclusion

Peritoneal hyaluronan in endothelial glycocalyx was more preserved in patients treated with low-GDP, pH-neutral solution. Loss of hyaluronan in the glycocalyx may induce proteins leakages, leading to the development of EPS in the patients treated with conventional solution.