Vascular Endothelial Cell Injury Is an Important Factor in the Development of Encapsulating Peritoneal Sclerosis in Long-Term Peritoneal Dialysis Patients.
Encapsulating peritoneal sclerosis (EPS) is a rare but serious and life-threatening complication of peritoneal dialysis (PD). However, the precise pathogenesis remains unclear; in addition, predictors and early diagnostic biomarkers for EPS have not yet to be established.



Eighty-three peritoneal membrane samples taken at catheter removal were examined to identify pathological characteristics of chronic peritoneal deterioration, which promotes EPS in patients undergoing long-term PD treatment with low occurrence of peritonitis.



According to univariable logistic regression analysis of the pathological findings, thickness of the peritoneal membrane (P = 0.045), new membrane formation score (P = 0.006), ratio of luminal diameter to vessel diameter (L/V ratio, P<0.001), presence of CD31-negative vessels (P = 0.021), fibrin deposition (P<0.001), and collagen volume fraction (P = 0.018) were associated with EPS development. In analyses of samples with and without EPS matched for PD treatment period, non-diabetes, and PD solution, univariable analysis identified L/V ratio (per 0.1 increase: odds ratio (OR) 0.44, P = 0.003) and fibrin deposition (OR 6.35, P = 0.027) as the factors associated with EPS. L/V ratio was lower in patients with fibrin exudation than in patients without fibrin exudation.



These findings suggest that damage to vascular endothelial cells, as represented by low L/V ratio, could be a predictive finding for the development of EPS, particularly in long-term PD patients unaffected by peritonitis.
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Mitsuhiro
M
Tawada
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yasuhiko
Y
Ito
Department of Nephrology, Juntendo University, Tokyo, Japan.
Chieko
C
Hamada
Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
Kazuho
K
Honda
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Masashi
M
Mizuno
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yasuhiro
Y
Suzuki
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Fumiko
F
Sakata
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Takeshi
T
Terabayashi
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yoshihisa
Y
Matsukawa
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Shoichi
S
Maruyama
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Enyu
E
Imai
Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Seiichi
S
Matsuo
Department of Biochemistry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yoshifumi
Y
Takei
D000328:Adult; D001808:Blood Vessels / Q000473:pathology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects; D042783:Endothelial Cells / Q000473:pathology*; D005260:Female; D005337:Fibrin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D010537:Peritoneum / Q000098:blood supply* / Q000473:pathology*; D010538:Peritonitis / Q000473:pathology*
D005337:Fibrin