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Cumulative Dialytic Glucose Exposure is a Risk Factor for Peritoneal Fibrosis and Angiogenesis in Pediatric Patients

Yoko Shirai1, Kenichiro Miura1, Takeshi Ike2

  • 1Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan.

Kidney International Reports
|December 19, 2022
PubMed

Insights

Cumulative high glucose exposure during peritoneal dialysis (PD) is linked to peritoneal fibrosis and angiogenesis in children. This suggests a potential risk for pediatric PD patients using neutral-pH fluids, impacting long-term outcomes.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Peritoneal Dialysis

Background:

  • Neutral-pH dialysate may prevent peritoneal pathological changes in adult PD patients, but its use in pediatric PD patients is debated.
  • The impact of cumulative dialytic glucose exposure on peritoneal health in pediatric PD patients remains unclear.

Purpose of the Study:

  • To compare peritoneal pathological changes between pediatric PD patients using conventional versus neutral-pH fluids.
  • To identify risk factors for peritoneal pathological changes in pediatric PD patients using neutral-pH fluids.
  • To explore the mechanisms underlying peritoneal pathological changes.

Main Methods:

  • Comparison of pediatric PD patients using conventional (n=31) or neutral-pH fluids (n=33).
  • Analysis of clinical risk factors using generalized linear modeling.
  • Exploration of mechanisms via immunohistochemical studies and cultured cells.

Main Results:

  • Neutral-pH group showed less submesothelial compact zone thickening and higher luminal-to-vessel diameter ratio post-propensity score matching.
  • Cumulative dialytic glucose exposure was an independent risk factor for increased submesothelial compact zone thickness and microvessel density in the neutral-pH group.
  • Glucose exposure correlated with hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor-α (VEGF-α) expression.

Conclusions:

  • Cumulative dialytic glucose exposure is an independent risk factor for peritoneal fibrosis and angiogenesis in pediatric PD patients using neutral-pH fluids.
  • This may be linked to increased VEGF-α production by myofibroblasts, suggesting a hypoxic response.
Abstract

Keywords:
fibrosispediatric nephrologyperitoneal dialysisperitoneal membrane

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