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Biocompatible Dialysis Solutions Preserve Peritoneal Mesothelial Cell and Vessel Wall Integrity. A Case-Control Study
Gloria del Peso1, José Antonio Jiménez-Heffernan2, Rafael Selgas3
1Servicio de Nefrología, Instituto de Investigación (IdiPAZ), Hospital Universitario La Paz, Madrid, Spain gloria.delpeso@salud.madrid.org.
Unlabelled:
♦
Introduction:
Chronic exposure to conventional peritoneal dialysis (PD) solutions has been related to peritoneal function alterations in PD patients, and associated with mesothelial cell loss, submesothelial fibrosis, vasculopathy, and angiogenesis. In vitro and ex vivo analyses, as well as studies with animal models, have demonstrated that biocompatible PD solutions attenuate these morphological alterations. Our aim was to confirm the morphological benefits of biocompatible solutions in PD patients. ♦
Methods:
We analyzed biopsies from 23 patients treated with biocompatible solutions (study group, SG), and compared them with a control group (n = 23) treated with conventional solutions (CG), matched for time on PD. ♦
Results:
A total of 56.5% of SG patients showed total or partial preservation of mesothelial cells monolayer, in contrast with 26.1% of patients in CG (p = 0.036). Peritoneal fibrosis was not significantly less frequent in SG patients (47.8% SG vs 69.6% CG; p = 0.13). In patients without previous peritonitis, a significantly lower prevalence of fibrosis was present in SG patients (41.7% SG vs 77.8% CG; p = 0.04). Hyalinizing vasculopathy (HV) was significantly lower in SG (4.3% SG vs 30.4% CG; p = 0.02). Cytokeratin-positive fibroblast-like cells were detected in 10 patients (22%), but the prevalence was not significantly lower in SG. In the univariate regression analysis, the use of biocompatible solutions was associated with mesothelial monolayer integrity (p = 0.04) and an absence of vasculopathy (p = 0.04). ♦
Conclusion:
The present study demonstrates in vivo in human biopsies that biocompatible solutions are better tolerated by the peritoneum in the medium and long term than conventional solutions.
Insights
Biocompatible peritoneal dialysis (PD) solutions better preserve the peritoneum in PD patients compared to conventional solutions. This study confirms morphological benefits, including mesothelial cell preservation and reduced vasculopathy, in human biopsies.
Area of Science:
- Nephrology
- Histopathology
- Peritoneal Dialysis
Background:
- Chronic exposure to conventional peritoneal dialysis (PD) solutions can lead to peritoneal function alterations, including mesothelial cell loss, fibrosis, vasculopathy, and angiogenesis.
- In vitro, ex vivo, and animal studies suggest biocompatible PD solutions may mitigate these morphological changes.
Purpose of the Study:
- To evaluate the in vivo morphological benefits of biocompatible PD solutions in human patients.
- To compare peritoneal tissue alterations between patients on biocompatible and conventional PD solutions.
Main Methods:
- Analysis of peritoneal biopsies from 23 patients on biocompatible solutions (study group) and 23 matched patients on conventional solutions (control group).
- Comparison of mesothelial cell preservation, submesothelial fibrosis, and hyalinizing vasculopathy between the groups.
Main Results:
- Significantly higher preservation of mesothelial cell monolayer in the study group (56.5%) compared to the control group (26.1%) (p=0.036).
- Lower prevalence of hyalinizing vasculopathy in the study group (4.3%) versus the control group (30.4%) (p=0.02).
- In patients without prior peritonitis, the study group showed significantly less fibrosis (41.7% vs 77.8%, p=0.04).
Conclusions:
- Biocompatible PD solutions demonstrate superior peritoneal tolerance in the medium and long term compared to conventional solutions.
- In vivo evidence from human biopsies supports the use of biocompatible solutions to maintain peritoneal integrity.
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