| Theme |
Trend in Peritoneal Dialysis Therapy After Implementation of Japanese Society for Dialysis Therapy (JSDT) Peritoneal Dialysis Guideline |
| Title |
Inhibitory effect of neutral peritoneal dialysate on morphological alterations |
| Author |
Chieko Hamada |
Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine |
| [ Summary ] |
Long-term exposure to incompatible peritoneal dialysis fluids (PDF) may induce functional and morphological alterations in patients receiving peritoneal dialysis (PD). The characteristics of morphological change include loss of mesothelial cells, fibrotic thickening of the submesothelial interstitium and vasculopathy of small vessels. Ultrafiltration failure, caused by increasing peritoneal permeability and dysfunctional immune response in the peritoneal cavity, are indicators of peritoneal dysfunction. Neutral PDF, neutral pH and low glucose degradation products demonstrate peritoneal efficacies. Neutral PDF plays various roles in the preservation of mesothelial cells and host defense of the peritoneal cavity as observed in animal models. Clinical studies indicated that neutral PDF provides beneficial effects on the preservation of residual renal function and retention of mesothelial cells. In our morphological examinations, development of peritoneal fibrosis and vasculopathy due to neutral PDF were suppressed by the presence of conventional acidic PDF. Further examinations of the functional and morphological effects of recently implemented preventive approaches such as peritoneal rest, leverage and combination therapy with hemodialysis and their effects on the peritoneum should be conducted. |