ESPN 51th Annual Meeting

ESPN 2018


 
Ex vivo validation of peritoneal membrane ultrasound findings in children on peritoneal dialysis
BETTI SCHAEFER 1 ABDULSATTAR ALRAJAB 5 JENS-PETER SCHENK 5 SARA TESTA 2 PETER SALLAY 3 GEMA ARICETA 4 AKOS UJSZASZI 1 MARIA BARTOSOVA 1 CLAUS P. SCHMITT 1

1- DIVISION OF PEDIATRIC NEPHROLOGY, CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE, UNIVERSITY OF HEIDELBERG, GERMANY
2- PEDIATRIC NEPHROLOGY AND DIALYSIS UNIT, FONDAZIONE IRCCS CA GRANDA OSPEDALE MAGGIORE POLICLINICO, MILAN, ITALY
3- FIRST DEPARTMENT OF PEDIATRICS, SEMMELWEIS UNIVERSITY, BUDAPEST, HUNGARY
4- HOSPITAL UNIVERSITARIO MATERNO-INFANTIL VALL D HEBRON, BARCELONA, SPAIN
5- DIVISION OF PEDIATRIC RADIOLOGY, CENTER FOR PEDIATRIC AND ADOLESCENT MEDICINE, UNIVERSITY OF HEIDELBERG, GERMANY
 
Introduction:

Peritoneal dialysis (PD) induces progressive peritoneal membrane transformation, i.e. increasing submesothelial fibrosis and angiogenesis, which deteriorate PD transport function. Measurement of peritoneal ultrastructure by ultrasound has repeatedly been suggested for evaluation of the PD membrane status, respective validation is scant.

Material and methods:

Within the scope of the International Pediatric Peritoneal Biopsy Study standardized parietal peritoneal tissue sampling was followed by ultrasound measurements in 24 children (median age 7.9 (4.2, 12.5) years). 12 children were at time of PD catheter insertion (CKD5), 12 on PD for 27.0 (5.6, 36.0) months; 5 had a history of peritonitis. The ultrasound of the area neighboring the sampling site was performed within one week of tissue sampling using a 13 und 18 MHz transducer. Peritoneal tissue samples underwent HE/CD31 staining and digital tissue imaging analyses, including peritoneal submesothelial thickness and microvessel density determination.

Results:

Peritoneal submesothelial tissue thickness was 285 (100, 459) µm. Respective minimal membrane thickness measured by ultrasound was 250 (200, 360) µm, maximal 330 (300, 410) µm and mean thickness 275 (250, 380) µm. Submesothelial thickness correlated with minimal (rho=0.556, p=0.020), maximal (rho=0.457, p=0.087) and mean peritoneal thickness measured by ultrasound (rho=0.427, p=0.078). Within the limits of small numbers, there was no difference in the accuracy in patients with and without history of previous peritonitis and in patients with CKD5 and while on PD. Tissue imaging technique did not improve imaging quality. Parietal peritoneal vessel density and omental tissue findings could not adequately be quantitated by means of ultrasound.

Conclusions:

Ultrasound measurements provide information on peritoneal membrane thickness. Repeated ultrasound measurements, which are related to previously published age related reference values, should give an estimate of fibrotic peritoneal membrane transformation. Precise information on peritoneal ultrastructural transformation also including inflammation and vascularization still require tissue sampling on occasion of abdominal surgery.