Nephrology Dialysis Transplantation, Vol 14, Issue 6 1541-1549, Copyright © 1999 by Oxford University Press
K Honda, K Nitta, S Horita, W Yumura, H Nihei, R Nagai, K Ikeda and S Horiuchi
Background: Ultra-filtration failure is a serious
complication of long-term continuous ambulatory peritoneal dialysis (CAPD).
This complication is related to histological changes of the peritoneum,
i.e. severe interstitial fibrosis and microvascular sclerosis. Although
their pathogenesis had not been elucidated yet, advanced glycation end
products (AGEs) have been shown to accumulate in the peritoneal tissue of
CAPD patients. Methods: Peritoneal biopsy specimens
from 14 CAPD patients with low ultra-filtration (n=9) and high
ultrafiltration (n=5) capacity were immunohistochemically investigated
using a monoclonal antibody against AGEs (6D12). The severity of peritoneal
fibrosis, microvascular sclerosis and intensity of AGE accumulation were
semi-quantitatively evaluated. Peritoneal ultra-filtration capacity was
evaluated by calculating daily ultrafiltration volume per bodyweight
(UFV/BW) and D/D0 (glucose) of the peritoneal equilibration test.
Results: In all patients with low ultra-filtration,
AGE accumulated in the peritoneal fibrous tissue and microvascular walls.
Remarkably, AGE accumulated more intensely in hyalinized fibrosis of small
venular media. Extent of AGE accumulation in peritoneal interstitium and
vascular walls correlated with the progression of interstitial fibrosis
(&rgr;=0.727, P=0.0088) and vascular sclerosis (&rgr;=0.915,
P=0.001). UFV/BW was inversely correlated to interstitial fibrosis
(&rgr;=-0.660, P=0.0174), microvascular sclerosis (&rgr;=-0.671,
P=0.0155) and microvascular sclerosis (&rgr;=-0.671, P=0.0145).
Conclusions: In CAPD patients, AGE formation in the
peritoneum correlates with the development of severe interstitial fibrosis
and microvascular sclerosis, which is associated clinically with impaired
peritoneal ultra-filtration. Key words: advanced
glycation end product; continuous ambulatory peritoneal dialysis;
peritoneal fibrosis; ultra-filtration failure; vascular changes
ORIGINAL ARTICLES
Accumulation of advanced glycation end products in the peritoneal vasculature of continuous ambulatory peritoneal dialysis patients with low ultra-filtration
Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan; Department of Biochemistry, Kumamoto University School of Medicine, Kumamoto, Japan; Corresponding author
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