Bouzin, Caroline

Crott, Ralph

Devuyst, Olivier

Goffin, Eric

Hautem, Nicolas

Morelle, Johann

Sow, Amadou

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DIALYSIS. PERITONEAL DIALYSIS - 1FP551 INTERSTITIAL FIBROSIS RESTRICTS OSMOTICWATERTRANSPORT IN ENCAPSULATING PERITONEAL SCLEROSISJohann Morelle1,2, Amadou Sow2, Nicolas Hautem2, Caroline Bouzin3,Ralph Crott4, Olivier Devuyst1,2,5 and Eric Goffin11Cliniques Universitaires Saint-Luc, Division of Nephrology, Brussels, Belgium,2Université catholique de Louvain, Laboratory of Nephrology, Institute ofExperimental and Clinical Research, Brussels, Belgium, 3Université catholique deLouvain, Imaging Platform, Institute of Experimental and Clinical Research,Brussels, Belgium, 4Université catholique de Louvain, Public Health, Brussels,Belgium, 5University of Zurich, Institute of Physiology, Zurich, SwitzerlandIntroduction and Aims: Encapsulating peritoneal sclerosis (EPS) is a rare butsevere complication of peritoneal dialysis (PD) characterized by an extensivefibrosis of the peritoneum leading to bowel encapsulation and obstruction.Changes in peritoneal water transport have been suggested to precede EPS, butthe mechanisms and potential predictive value of that transport defect have notbeen investigated.Methods: Among 234 end-stage renal disease patients who initiated PD at ourinstitution over a 20-year period, we evaluated changes in peritoneal transportover time on PD in 7 patients who subsequently developed EPS and in 28matched controls, using 3.86% glucose peritoneal equilibration tests. We nextassessed the molecular and structural mechanisms of impaired water transport inEPS using expression, structural and biochemical analyses of the peritonealmembrane.Results: As compared with long-term PD controls, patients with EPS showed anearly loss of UF capacity and sodium sieving before the onset of overt EPS.Multivariate analysis revealed that loss of sodium sieving was the most powerfulpredictor of EPS in this cohort. The EPS peritoneum showed a thickersubmesothelial fibrosis, with increased collagen density and greater amount ofthick collagen fibers, as compared with long-term PD controls and uremicpatients. Reduced osmotic conductance strongly correlated with the degree ofperitoneal fibrosis, but not with vasculopathy. Peritoneal fibrosis was paralleled byan excessive upregulation of vascular endothelial growth factor and endothelialnitric oxide synthase, while the expression of endothelial aquaporin-1 waterchannels was unaltered.Conclusions: Our findings suggest that an early and disproportionate reduction inosmotic conductance during the course of PD is an independent predictor of EPS.This functional change is linked to specific alterations of the collagen matrix inthe peritoneal membrane of patients with EPS, thereby validating the serial threepore membrane/fiber matrix and distributed models of peritoneal transport.© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.Nephrology Dialysis Transplantation 30 (Supplement 3): iii257–iii275, 2015doi:10.1093/ndt/gfv180.3

FP551INTERSTITIAL FIBROSIS RESTRICTS OSMOTIC WATER TRANSPORT IN ENCAPSULATING PERITONEAL SCLEROSIS

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FP551INTERSTITIAL FIBROSIS RESTRICTS OSMOTIC WATER TRANSPORT IN ENCAPSULATING PERITONEAL SCLEROSIS

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