Shorter daily dwelling time in peritoneal dialysis attenuates the epithelial-to-mesenchymal transition of mesothelial cells

Yi-Che Lee,Shih-Yuan Hung,Hsin-Pao Chen,Sheng-Hsiang Lin,Hao-Kuang Wang,Yi-Ting Chen,Tsun-Mei Lin,Min-Yu Chang,Li-Chun Ho,Yau-Sheng Tsai,Hung-Hsiang Liou,Hsiang-Chun Liu,Hsi-Hao Wang,Kuang-Wen Liu,Hong-Arh Fan,Yung-Tang Kung,Yuan-Yow Chiou

doi:10.1186/1471-2369-15-35

Abstract

BackgroundPeritoneal dialysis (PD) therapy is known to induce morphological and functional changes in the peritoneal membrane. Long-term exposure to conventional bio-incompatible dialysate and peritonitis is the main etiology of inflammation. Consequently, the peritoneal membrane undergoes structural changes, including angiogenesis, fibrosis, and hyalinizing vasculopathy, which ultimately results in technique failure. The epithelial-to-mesenchymal transition (EMT) of mesothelial cells (MCs) plays an important role during the above process; however, the clinical parameters associated with the EMT process of MCs remain to be explored.MethodsTo investigate the parameters impacting EMT during PD therapy, 53 clinical stable PD patients were enrolled. EMT assessments were conducted through human peritoneal MCs cultured from dialysate effluent with one consistent standard criterion (MC morphology and the expression of an epithelial marker, cytokeratin 18). The factors potentially associated with EMT were analyzed using logistic regression analysis. Primary MCs derived from the omentum were isolated for the in vitro study.ResultsForty-seven percent of the patients presented with EMT, 28% with non-EMT, and 15% with a mixed presentation. Logistic regression analysis showed that patients who received persistent PD therapy (dwelling time of 24 h/day) had significantly higher EMT tendency. These results were consistent in vitro.ConclusionsDwelling time had a significant effect on the occurrence of EMT on MCs.

Highlights

Peritoneal dialysis (PD) therapy is known to induce morphological and functional changes in the peritoneal membrane
All patients were primarily treated with a conventional dialysate, which contains high glucose, lactate, and glucose degradation products (Dianeal; Baxter), and some patients were treated with icodextrin-containing solution (Extraneal; Baxter)
Effects of dwelling time on the epithelialto-mesenchymal transition (EMT) of mesothelial cells (MCs) All patients were primarily treated with a conventional dialysate consisting of high glucose, lactate, and glucose degradation products (GDPs) concentrations (Dianeal; Baxter)

Summary

Introduction

Peritoneal dialysis (PD) therapy is known to induce morphological and functional changes in the peritoneal membrane. Long-term exposure to conventional bio-incompatible dialysate and peritonitis is the main etiology of inflammation. The peritoneal membrane undergoes structural changes, including angiogenesis, fibrosis, and hyalinizing vasculopathy, which results in technique failure. The main causes of treatment failure are the development of recurrent peritonitis, loss of residual renal function, inadequate solute clearance, and loss of peritoneal membrane function [3]. Continuous exposure to conventional bio-incompatible dialysate, which is acidic and contains large amounts of glucose degradation products (GDPs), is thought to be one of the main causes of peritoneal morphological and functional deterioration [6,7]. The efficiency of dialysis decreases and leads to PD failure [11]

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