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Accumulation of advanced glycation end products and beta 2-microglobulin in fibrotic thickening of the peritoneum in long-term peritoneal dialysis patients

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  • Artificial Kidney / Dialysis
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Abstract

Characteristics of pathological alterations in long-term peritoneal dialysis (PD) are thickening of submesothelial compact (SMC) zone, small-vessel vasculopathy, and loss of mesothelial cells. Bioincompatible PD fluid plays crucial roles in peritoneal injury. Encapsulating peritoneal sclerosis (EPS), a rare and serious complication, occurred in patients on long-term PD or frequent peritonitis episodes, and ~50 % of EPS developed after PD cessation. We hypothesized that PD-related peritoneal injury factors induced by bioincompatible PD fluid accumulated in the peritoneum and might induce EPS. We therefore examined the accumulation of advanced glycation end products (AGE) and beta 2-microglobulin (β2M) in peritoneum and evaluated the relationship between their accumulation, clinical parameters, and outcome after PD cessation. Forty-five parietal peritoneal specimens were obtained from 28 PD patients, 14 uremic patients, and three patients with normal kidney function. The peritoneal equilibration test was used for peritoneal function. AGE- and β2M-expressing areas were found in vascular walls, perivascular areas, and the deep layer of the SMC in short-term PD patients and extended over the entire SMC in long-term patients. Peritonitis and prolonged PD treatment aggravated peritoneal thickening and the proportion of AGE-expressing areas. The proportion of β2M-expressing areas was increased in long-term PD patients. Thickening of the SMC and the proportions of AGE- and β2M-expressing areas were not related to ascites or EPS after PD withdrawal. It appears that the increased proportion of AGE and β2M deposition induced by long-term exposure of PD fluid may be a marker of peritoneal injury.

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We have no conflict of interest.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hirotaka Nakamoto, Chieko Hamada, Tetsutaro Shimaoka, Yoshimi Sekiguchi, Hiroaki Io, Kayo Kaneko, Satoshi Horikoshi & Yasuhiko Tomino

Authors
  1. Hirotaka Nakamoto
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  2. Chieko Hamada
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  3. Tetsutaro Shimaoka
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  4. Yoshimi Sekiguchi
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  5. Hiroaki Io
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  6. Kayo Kaneko
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  7. Satoshi Horikoshi
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  8. Yasuhiko Tomino
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Corresponding author

Correspondence to Chieko Hamada.

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Deceased: H. Nakamoto.

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Nakamoto, H., Hamada, C., Shimaoka, T. et al. Accumulation of advanced glycation end products and beta 2-microglobulin in fibrotic thickening of the peritoneum in long-term peritoneal dialysis patients. J Artif Organs 17, 60–68 (2014). https://doi.org/10.1007/s10047-013-0741-1

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  • DOI: https://doi.org/10.1007/s10047-013-0741-1

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