title: Neutral solution low in glucose degradation products is associated with less peritoneal fibrosis and vascular sclerosis in patients receiving peritoneal dialysis.
abstract: BACKGROUND
  The effects of novel biocompatible peritoneal dialysis (PD) solutions on human peritoneal membrane pathology have yet to be determined. Quantitative evaluation of human peritoneal biopsy specimens may reveal the effects of the new solutions on peritoneal membrane pathology. ♢
  
  
  METHODS
  Peritoneal specimens from 24 PD patients being treated with either acidic solution containing high-glucose degradation products [GDPs (n = 12)] or neutral solution with low GDPs (n = 12) were investigated at the end of PD. As controls, pre-PD peritoneal specimens, obtained from 13 patients at PD catheter insertion, were also investigated. The extent of peritoneal fibrosis, vascular sclerosis, and advanced glycation end-product (AGE) accumulation were evaluated by quantitative or semi-quantitative methods. The average densities of CD31-positive vessels and podoplanin-positive lymphatic vessels were also determined. ♢
  
  
  RESULTS
  Peritoneal membrane fibrosis, vascular sclerosis, and AGE accumulation were significantly suppressed in the neutral group compared with the acidic group. The neutral group also showed lower peritoneal equilibration test scores and preserved ultrafiltration volume. The density of blood capillaries, but not of lymphatic capillaries, was significantly increased in the neutral group compared with the acidic and pre-PD groups. ♢
  
  
  CONCLUSIONS
  Neutral solutions with low GDPs are associated with less peritoneal membrane fibrosis and vascular sclerosis through suppression of AGE accumulation. However, contrary to expectation, blood capillary density was increased in the neutral group. The altered contents of the new PD solutions modified peritoneal membrane morphology and function in patients undergoing PD.
authors.affiliation: Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Kawanishi
authors.forename: Kazuho
authors.initials: K
authors.lastname: Honda
authors.forename: Misao
authors.initials: M
authors.lastname: Tsukada
authors.forename: Hideaki
authors.initials: H
authors.lastname: Oda
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000328:Adult; D001639:Bicarbonates / Q000032:analysis; D001672:Biocompatible Materials; D001808:Blood Vessels / Q000473:pathology; D002196:Capillaries / Q000473:pathology; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D056627:Peritoneal Fibrosis; D010537:Peritoneum / Q000378:metabolism; D012598:Sclerosis; D014462:Ultrafiltration
chemical_list: D001639:Bicarbonates; D001672:Biocompatible Materials; D015314:Dialysis Solutions; D017127:Glycation End Products, Advanced; D005947:Glucose
keywords: AGEs; GDPs; angiogenesis; biocompatible solution; peritoneal fibrosis; vascular sclerosis