title: New Insights into the Effects of Chronic Kidney Failure and Dialysate Exposure on the Peritoneum.
abstract: ♦ INTRODUCTION: Chronic uremia and the exposure to dialysis solutions during peritoneal dialysis (PD) induce peritoneal alterations. Using a long-term peritoneal exposure model, we compared the effects of chronic kidney failure (CKD) itself and exposure to either a 'conventional' or a 'biocompatible' dialysis solution on peritoneal morphology and function. ♦ METHODS: Wistar rats (Harlan, Zeist, the Netherlands) were grouped into: normal kidney function (NKF), CKD induced by 70% nephrectomy, CKD receiving daily peritoneal infusions with 3.86% glucose Dianeal (CKDD), or Physioneal (both solutions from Baxter Healthcare, Castlebar, Ireland) (CKDP). At 16 weeks, a peritoneal function test was performed, and histology, ultrastructure, and hydroxyproline content of peritoneal tissue were assessed. ♦ RESULTS: Comparing CKD with NKF, peritoneal transport rates were higher, mesothelial cells (MC) displayed increased number of microvilli, blood and lymph vasculature expanded, vascular basal lamina appeared thicker, with limited areas of duplication, and fibrosis had developed. All alterations, except lymphangiogenesis, were enhanced by exposure to both dialysis fluids. Distinct MC alterations were observed in CKDD and CKDP, the latter displaying prominent basolateral protrusions. In addition, CKDP was associated with a trend towards less fibrosis compared to CKDD. ♦ CONCLUSIONS: Chronic kidney failure itself induced peritoneal alterations, which were in part augmented by exposure to glucose-based dialysis solutions. Overall, the conventional and biocompatible solutions had similar long-term effects on the peritoneum. Importantly, the latter may attenuate the development of fibrosis.
authors.affiliation: Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands c.a.vlahu@amc.uva.nl.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Vlahu
authors.affiliation: Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Aten
authors.affiliation: Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marijke
authors.initials: M
authors.lastname: de Graaff
authors.affiliation: Van Leeuwenhoek Center for Advanced Microscopy, Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: van Veen
authors.affiliation: Van Leeuwenhoek Center for Advanced Microscopy, Department of Cell Biology and Histology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: Everts
authors.affiliation: Tygat Institute for Liver and Intestinal Research, Amsterdam, The Netherlands.
authors.forename: Dirk R
authors.initials: DR
authors.lastname: de Waart
authors.affiliation: Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.|Dianet Foundation, Amsterdam-Utrecht, The Netherlands.
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Struijk
authors.affiliation: Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Krediet
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D015314:Dialysis Solutions / Q000009:adverse effects / Q000494:pharmacology*; D004195:Disease Models, Animal; D004848:Epithelium / Q000187:drug effects / Q000473:pathology*; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D009392:Nephrectomy / Q000379:methods; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D056627:Peritoneal Fibrosis / Q000209:etiology / Q000473:pathology*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D015314:Dialysis Solutions
keywords: Peritoneal dialysis; biocompatible dialysis solutions; electron microscopy; image analysis; lymphangiogenesis; stereology