title: Accumulation of advanced glycation end products and beta 2-microglobulin in fibrotic thickening of the peritoneum in long-term peritoneal dialysis patients.
abstract: Characteristics of pathological alterations in long-term peritoneal dialysis (PD) are thickening of submesothelial compact (SMC) zone, small-vessel vasculopathy, and loss of mesothelial cells. Bioincompatible PD fluid plays crucial roles in peritoneal injury. Encapsulating peritoneal sclerosis (EPS), a rare and serious complication, occurred in patients on long-term PD or frequent peritonitis episodes, and ~50 % of EPS developed after PD cessation. We hypothesized that PD-related peritoneal injury factors induced by bioincompatible PD fluid accumulated in the peritoneum and might induce EPS. We therefore examined the accumulation of advanced glycation end products (AGE) and beta 2-microglobulin (β2M) in peritoneum and evaluated the relationship between their accumulation, clinical parameters, and outcome after PD cessation. Forty-five parietal peritoneal specimens were obtained from 28 PD patients, 14 uremic patients, and three patients with normal kidney function. The peritoneal equilibration test was used for peritoneal function. AGE- and β2M-expressing areas were found in vascular walls, perivascular areas, and the deep layer of the SMC in short-term PD patients and extended over the entire SMC in long-term patients. Peritonitis and prolonged PD treatment aggravated peritoneal thickening and the proportion of AGE-expressing areas. The proportion of β2M-expressing areas was increased in long-term PD patients. Thickening of the SMC and the proportions of AGE- and β2M-expressing areas were not related to ascites or EPS after PD withdrawal. It appears that the increased proportion of AGE and β2M deposition induced by long-term exposure of PD fluid may be a marker of peritoneal injury.
authors: Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors: Hirotaka
authors: H
authors: Nakamoto
authors: Chieko
authors: C
authors: Hamada
authors: Tetsutaro
authors: T
authors: Shimaoka
authors: Yoshimi
authors: Y
authors: Sekiguchi
authors: Hiroaki
authors: H
authors: Io
authors: Kayo
authors: K
authors: Kaneko
authors: Satoshi
authors: S
authors: Horikoshi
authors: Yasuhiko
authors: Y
authors: Tomino
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D015314:Dialysis Solutions / Q000009:adverse effects*; D005355:Fibrosis; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D056627:Peritoneal Fibrosis / Q000139:chemically induced / Q000378:metabolism*; D010537:Peritoneum / Q000187:drug effects / Q000378:metabolism* / Q000473:pathology; D055815:Young Adult; D001613:beta 2-Microglobulin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D015314:Dialysis Solutions; D017127:Glycation End Products, Advanced; D001613:beta 2-Microglobulin