Advanced Research Institute for Health Science, Faculty of Medicine, Juntendo University, Tokyo, Japan,
Asian Pacific Renal Research Promotion Office, Medical Corporation SHOWAKAI, Tokyo, Japan.
Blood Purif. 2021;50(6):719-728. doi: 10.1159/000510282. Epub 2021 Feb 10.
The thin peritoneum covering the peritoneal cavity has been used as a dialysis membrane for peritoneal dialysis (PD) because it is highly vascularized and has a large body surface area. However, it has been reported that peritoneal membranes affected by peritonitis, as well as those exposed to the nonphysiological high glucose levels containing PD dialysate, may undergo histological and functional changes. Patients undergoing PD may experience encapsulating peritoneal sclerosis (EPS), which is a life-threatening serious complication of PD that can significantly impair activities of daily living. The incidence of EPS was 1.4-7.3% of maintenance PD patients in the 1980s. The incidence has improved to 1.0% after a neutral dialysate became the standard PD treatment in Japan. Furthermore, the pathogenesis of EPS is uncertain although its onset may be explained by the "two-hit theory," in which some factors leading to impairment had an additive effect on simple peritoneal sclerosis. The evaluation of histopathological findings has shown the impact of the neutral dialysate on peritoneal deterioration as well as its role in the development of functional changes. In the present report, we discuss the advances in the understanding of peritoneal deterioration based on histological and macroscopic evaluations of the peritoneum of patients undergoing PD. We also discuss the recent treatment for PD patients.
腹膜腔的薄腹膜被用作腹膜透析 (PD) 的透析膜，因为它具有高度血管化和较大的体表面积。然而，据报道，腹膜炎影响的腹膜以及暴露于含有 PD 透析液的非生理高葡萄糖水平下的腹膜可能会发生组织学和功能变化。接受 PD 的患者可能会经历包裹性腹膜硬化症 (EPS)，这是 PD 的一种危及生命的严重并发症，可显著影响日常生活活动。在 20 世纪 80 年代，维持性 PD 患者中 EPS 的发病率为 1.4-7.3%。在日本，中性透析液成为 PD 的标准治疗方法后，发病率已改善至 1.0%。此外，尽管其发病机制可能可以用“双打击理论”来解释，即导致损伤的某些因素对单纯性腹膜硬化症有累加效应，但 EPS 的发病机制仍不确定。对组织病理学发现的评估表明，中性透析液对腹膜恶化的影响及其在功能变化发展中的作用。在本报告中，我们讨论了基于 PD 患者腹膜的组织学和宏观评估对腹膜恶化的认识进展。我们还讨论了 PD 患者的最近治疗方法。
