ESPN 51th Annual Meeting

ESPN 2018


 
PERITONITIS EPISODES DO NOT PERSISTENTLY ALTER PERITONEAL MEMBRANE IN CHILDREN ON LOW GDP PERITONEAL DIALYSIS
BETTI SCHAEFER 1 MARIA BARTOSOVA 1 RIMANTE CERKAUSKIENE 2 ARIANE ZALOSZYC 3 KAREL VONDRAK 4 SARA TESTA 5 CHRISTINA TAYLAN 6 RAFAEL T. KRMAR 7 RAINER BÜSCHER 8 BRADLEY A. WARADY 9 FRANZ SCHAEFER 1 AKOS UJSZASZI 1 CLAUS P. SCHMITT 1

1- DIVISION OF PEDIATRIC NEPHROLOGY, CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE, UNIVERSITY OF HEIDELBERG, GERMANY
2- PEDIATRIC CENTER, VILNIUS UNIVERSITY, LITHUANIA
3- DEPARTMENT OF PEDIATRICS 1, UNIVERSITY HOSPITAL OF STRASBOURG,STRASBOURG, FRANCE
4- DEPARTMENT OF PEDIATRICS, UNIVERSITY HOSPITAL MOTOL, PRAGUE, CZECH REPUBLIC
5- PEDIATRIC NEPHROLOGY AND DIALYSIS UNIT, FONDAZIONE IRCCS CA GRANDA OSPEDALE MAGGIORE POLICLINICO, MILAN, ITALY
6- PEDIATRIC NEPHROLOGY, CHILDRENS AND ADOLESCENTS HOSPITAL, UNIVERSITY HOSPITAL OF COLOGNE, GERMANY
7- DIVISION OF PEDIATRICS, DEPARTMENT FOR CLINICAL SCIENCE, INTERVENTION AND TECHNOLOGY, KAROLINSKA INSTITUTE, KAROLINSKA UNIVERSITY HOSPITAL, HUDDINGE, STOCKHOLM, SWEDEN
8- PEDIATRIC NEPHROLOGY, UNIVERSITY CHILDREN`S HOSPITAL, ESSEN, GERMANY
9- CHILDRENS MERCY HOSPITAL, KANSAS CITY, MO, USA
 
Introduction:

The impact of peritoneal dialysis (PD) associated peritonitis on peritoneal membrane integrity is incompletely understood. Experimental studies suggest major peritonitis induced membrane alteration, respective human data is scant.

Material and methods:

Within the International Pediatric Peritoneal Biopsy Study standardized parietal peritoneal tissue samples were obtained from 84 children on low GDP PD. 37 patients had a history of peritonitis, 16 of these had two or more episodes: The last peritonitis was 9 (4, 36) weeks ago. Median age was 6.2 (2.6, 13.2) years, PD vintage 15.0 (8.5, 32.9) months. Specimens underwent digital histomorphometry and molecular tissue analyses.

Results:

Patients with peritonitis were on PD for 21.0 (12.0, 36.0) months, peritonitis free patients 12.8 (7.3, 27.0) months (p=0.053), but did not differ in anthropometric or histomorphometric parameters (mesothelial coverage, submesothelial fibrosis, blood and lymphatic vascularization, monocyte, macrophage and activated fibroblast numbers, endothelial-mesenchymal transition (EMT), podoplanin positivity and vasculopathy). VEGF and TGF-ß induced pSMAD abundance were similar. Matching for age and PD vintage (24 patients/group) and a subgroup analysis according to time since last peritonitis (<3, <6, >6 months) also did not reveal any differences. Beyond 24 months of PD, submesothelial thickness, ASMA positive fibroblast and CD45 lymphocyte scores were higher in patients with a peritonitis history (both p<0.05), these differences, however, did not persist in multivariate analyses. In both group together, PD duration and EMT were independently associated with submesothelial thickness; glucose exposure and EMT with peritoneal vessel density.

Conclusions:

Our detailed analysis of the peritoneal membrane in pediatric patients on low GDP PD, who are largely devoid of preexisting tissue alterations, does not support the notion of consistent long-term impact of peritonitis episodes on the peritoneal membrane ultrastructure, on inflammatory and fibrotic cell activity and EMT. Peritoneal alterations are driven by PD duration and dialytic glucose exposure.