SP438BIOCOMPATIBLE SOLUTIONS REDUCE THE INCIDENCE OF PERITONEAL HYALINIZING VASCULOPATHY, A LESION WITH UNCERTAIN SIGNIFICANCE

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Introduction and Aims: Peritoneal fibrosis and hyalinazing vasculopathy (HV) are consequences of medium-term peritoneal dialysis (PD) treatment. Bioincompatible (BINC) fluids induce mesothelial cell denudation and peritoneal fibrosis which is reduced using biocompatible (BC) solutions. Few studies have focused on the potential influence of biocompatibility on HV development. Surprisingly, angiogenesis has been described in biopsies under biocompatible solutions. Our aim was to study HV in 46 peritoneal biopsies taken from patients matched for time on PD, peritonitis incidence and peritoneal glucose load, and separated by the exclusive use of BC (n=23) vs. BINC (n=23) PD fluids. Methods: Peritoneal biopsies were mostly taken during kidney transplantation. HV was classified in four degrees (0, I, II and III) according to capillary wall thickening. Results: Prevalence of HV was significantly lower in BC group (4.3% vs. 30.4%, BINC, p=0.02). The average score was lower in this group (0.09±0.41 vs. 0.48±0.8, BINC, p=0.05). In peritonitis-free BC patients HV was absent, in contrast to 33.3% in BINC patients (p=0.025). Patients with prior peritonitis showed similar HV prevalence (p=0.54). Among non-diabetic patients, HV was less prevalent in BC (5% vs. 28.6%, BINC, p=0.045). In the univariate analysis, BINC solutions use was the only factor predicting HV (odds ratio 9.62; confidence interval: 1.07-86.17, p=0.04), after adjusting for age, time on PD, peritonitis, and diabetes in the multivariate analysis. All patients with HV had submesothelial fibrosis and partial or total mesothelial denudation. Relative to peritoneal transport parameters only UF capacity was significantly lower in BC group. The presence of HV was not associated with peritoneal protein losses or water transport (Na sieving).

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