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Abstract Introduction: Monitoring water quality in mobile dialysis (MD) services, assessing critical points and characterizing the risks inherent in the process, is essential to avoid risks to the patient's health. This study evaluated the microbiological quality of water in the MD of 36 hospitals with intensive treatment in the city of Rio de Janeiro. Methods: 204 water samples were collected from the points of entry to the network (NET), post-osmosis (PO) and dialysis solution (DS). The samples were evaluated for heterotrophic bacteria count, pathogen search, presence of endotoxins and aluminum content. Results: Bacterial contamination at 3 collection points in 36 hospitals was 30% (32/108); 42% from DS, 31% from PO and 17% from NET, with the presence of Pseudomonas aeruginosa, Stenotrophomonas maltophilia , Burkholderia cepacia and Ralstonia pickettii in the 3 points. Endotoxin concentrations above 0.25 EU/mL occurred in 77% of the samples (17/22) analyzed in the PO. In the aluminum content, values above 0.01 mg/L were presented in 47% (7/15) of PO samples and 27% (4/15) of NET samples. There is no specific legislation for water used in the MD; therefore, the limits of the RDC of the National Health Surveillance Agency (Anvisa) 11/2014 were used; which regulates conventional hemodialysis services. Conclusion: The results highlight the importance of evaluating water quality in MD services to ensure patient safety and support the sanitary monitoring of this process as a healthcare promoter.
Resumo Introdução: Monitorar a qualidade da água nos serviços de diálise móvel (DM), avaliando os pontos críticos e caracterizando os riscos inerentes ao processo, é fundamental para evitar riscos à saúde do paciente. Este estudo avaliou a qualidade microbiológica da água na DM de 36 hospitais com tratamento intensivo no município do Rio de Janeiro. Métodos: Foram coletadas 204 amostras de água dos pontos de entrada da rede (REDE), pós-osmose (PO) e solução de diálise (SD). As amostras foram avaliadas quanto à contagem de bactérias heterotróficas, pesquisa de patógenos, presença de endotoxinas e teor de alumínio. Resultados: A contaminação bacteriana, em 3 pontos de coleta nos 36 hospitais, foi de 30% (32/108), sendo 42% provenientes da SD, 31% da PO e 17% da REDE, com presença de Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia e Ralstonia pickettii nos 3 pontos. Concentrações de endotoxina acima de 0,25 EU/mL ocorreram em 77% das amostras (17/22) analisadas na PO. No teor de alumínio, os valores acima de 0,01 mg/L foram apresentados em 47% (7/15) das amostras da PO e 27% (4/15) das amostras da REDE. Não existe uma legislação específica para água utilizada na DM; logo, foram utilizados os limites da RDC da Agência Nacional de Vigilância Sanitária (Anvisa) 11/2014, que regulamenta os serviços de hemodiálise convencional. Conclusão: Os resultados ressaltam a importância da avaliação da qualidade da água nos serviços de DM para garantir a segurança do paciente e subsidiar o monitoramento sanitário desse processo como um promotor de saúde.
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Objective:To investigate the effects of Yishen Decoction via colonic dialysis on intestinal flora and microinflammation in patients with chronic kidney disease (CKD) stages 3-5. Methods:A total of 156 patients with stage 3-5 CKD from the Second Affiliated Hospital of Guizhou University of Chinese medicine from October 2019 to October 2020 who met the inclusion criteria were divided into 2 groups of 78 patients according to the random number table method. The control group was given colonic dialysis treatment, the treatment group was given Yishen Decoction transcolonic dialysis treatment on the basis of the control group, and both groups were treated for 8 weeks. TCM syndrome scores were performed before and after treatment, serum levels of CRP, IL-6, and TNF-α were measured by ELISA, and SCR, BUN, and uric acid (UA) levels were detected by a fully automated biochemical analyzer. Fresh feces were collected from the patients, anaerobic culture and aerobic culture were performed, and the numbers of Bifidobacterium, Lactobacillus acidophilus, and Escherichia coli were counted to evaluate the clinical efficacy. Results:The total effective rate was 97.4% (76/78) in the treatment group and 84.6% (66/78) in the control group, and the difference was statistically significant ( χ2=7.847, P=0.005). At 4 and 8 weeks after treatment, the scores of lumbar and knee tenderness( t=6.596, 8.792), eating less and being dull ( t=12.060, 24.140) and pale complexion ( t=7.983, 12.300) in the treatment group were significantly lower than those in the control group ( P<0.01); the levels of bifidobacterium ( t=4.037, 2.358) and Lactobacillus acidophilus ( t=7.352, 2.092) were significantly higher than those in the control group, while the levels of Escherichia coli ( t=3.822, 6.084) were significantly lower than those in the control group ( P<0.01 or P<0.05). The serum CRP ( t=9.326, 12.300), IL-6 ( t=4.591, 4.716), TNF-α ( t=9.304, 9.775), SCr ( t=17.630, 11.530), BUN ( t=2.674, 2.248), UA ( t=10.860, 13.160) were significantly lower than those in the control group ( P<0.01 or P<0.05). Conclusion:Yishen Decoction can improve intestinal microecological status, inhibit microinflammatory response and relieve clinical symptoms for the patients with stage 3-5 CKD.
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Hemodialysis water and dialysates are fundamental in the treatment of kidney disease. During just one hemodialysis session, 120 liters of dialysate are consumed. Thus, it is essential that the parameters of chemical and microbiological quality of the fluids used in dialysis systems are carefully observed. In this study, water samples were collected at 12 hospitals in the state of Rio de Janeiro. The samples were obtained at three points of fluid reservoirs: pre-, post-osmosis and dialysis solution. After collection, colony forming units (CFU), total coliforms and Escherichia coli 100 mL-1 were quantified. Later, isolated colonies and endotoxin content were identified by biochemical assays. Data about total aluminum levels per sample (mg L-1) were also obtained. Samples of all mobile dialysis services and points of collection were contaminated above the levels set out by national laws, in particular by Pseudomonas aeruginosa. Endotoxin levels were also above the recommended by current legislation (> 0.25 EU mL-1). Only three samples contained detectable levels of aluminum, which were found to be above the recommended values for the corresponding resolution (0.01 mg L-1). Finally, there were no observable amounts of total coliforms and E. coli 100 mL-1 sample. The data from this study are an important step forward in the standardization and control of chemical/microbiological quality of mobile dialysis services.
Águas de hemodiálise e dialisatos são peças fundamentais na terapêutica da doença renal. Durante apenas uma sessão de hemodiálise, são consumidos aproximadamente 120 litros de dialisato. Desta forma, é essencial que os parâmetros de qualidade microbiológica e química dos fluidos utilizados em sistemas de diálise sejam cuidadosamente observados. Neste trabalho, foram coletadas amostras de água em 12 hospitais do Estado do Rio de Janeiro. Amostras foram obtidas em pontos pré-osmose, pós-osmose e solução de diálise. Após coleção, quantificaram-se unidades formadoras de colônias (UFC), coliformes totais e Escherichia coli 100 mL-1. Posteriormente, colônias isoladas e teor de endotoxinas foram identificados por ensaios bioquímicos. Dados acerca dos níveis totais de alumínio por amostra (mg L-1) também foram obtidos. Amostras de todos os serviços de diálise móvel e pontos de coleção apresentaram contaminação acima dos níveis previstos em legislação nacional, em especial por Pseudomonas aeruginosa. Teores de endotoxinas também se mostraram acima da legislação vigente (> 0,25 EU mL-1). Apenas três amostras continham níveis detectáveis e acima dos valores preconizados por resolução correspondente (0,01 mg L-1). Por fim, não foram encontradas quantidades observáveis de coliformes totais e E. coli 100 mL-1 de amostra. Dados de nosso estudo são importante avanço na padronização e controle de qualidade química/microbiológica em serviços de diálise móvel.
Subject(s)
Dialysis , Dialysis Solutions , Hemodialysis Units, HospitalABSTRACT
Objective To study the effects of low calcium dialysate on bone mineral density (BMD) in old patients with low turnover renal osteodystrophy under maintenance hemodialysis.Methods Totally 72 elderly patients aged≥ 60 years under MHD for 6 months or more with parathyroid hormone(iPTH)＜100 ng/L were selected and randomly divided into treatment group(n=36,calcium 1.25 mmol/L in dialysate)and a control group(n =36,calcium 1.5 mmol/L in dialysate),for 12 months of treatment.The changes of albumin-corrected calcium and phosphorus,calciumphosphorus product,iPTH level,bone mineral density,and other indicators as well as related adverse events were observed before and 12 months after the study.Results There was no statistically significant difference in general conditions and the correlated laboratory examinations between the two groups before and after treatment (P ＞ 0.05).After dialytic treatments with dialysate containing calcium 1.25 mmol/L for 12 months,the therapy group versus pre-therapy and control group showed statistically significant decrease in parameters of mean arterial pressure(MAP) [(88.6 ± 9.2) vs.(92.6±10.4)and(93.7±8.8)mmHg],serum calcium[(2.4±0.1)vs.(2.6±0.3)and(2.6±0.2)mmol/L,t =5.061,5.074],phosphorus[(2.0±0.2)vs.(2.1 ±0.2)and(2.1±0.3)mmol/L,t=2.276,2.271],calcium-phosphorus product[(4.7 ± 0.5) vs.(5.3 ± 0.6) and (5.4 ± 0.7) mmol2 / L2,t =4.682,4.627](all P＜0.05),and showed statistically significant increase in parameters of iPTH levels[(132.6 ±37.8) vs.(71.3 ± 11.48) and (69.7 ± 16.0) ng/L;t value 8.824 and 9.048,respectively],bone mineral density values(Lumbar:0.8±0.9 vs.-1.2±1.1 and-1.2±1.1;t value 2.170 and 2.170,respectivly.Femoral neck:-0.8± 1.0 vs.1.3±1.2 and-1.3±1.3;t value 2.258 and 2.243,respectively) (all P＜0.05).In the control group after 12 months of treatment with calcium 1.5mmol/L dialysate,there was no significant difference in related parameters (P＞ 0.05).There was no significant difference in the adverse reactions between study and control groups (P ＞ 0.05).Conclusions The low calcium dialysate(calcium 1.25 mmol/L)used in elderly patients with iPTH＜100 ng/L under MHD can effectively improve the excessive depression of parathyroid function and the decreased BMD,and better control the albumin corrected calcium,phosphorus,calcium-phosphorus product level,and has a good security.
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Hemoperitoneum is not uncommon in patients receiving peritoneal dialysis (PD)be-cause the PD catheter provides a window to the peritoneum.Gynecological associated phenomena account for the majority of cases.Intra-abdominal pathology of solid organs such as the kidney,liver,and spleen as well as the gastrointestinal tract is recognized.Unique to PD patients,hemoperitoneum may be associated with the catheter itself,uremic bleeding,or peritonitis.The choice of treatment depends largely on the cau-ses of hemorrhage.This paper reviews hemoperitoneum in adult PD patients.
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Objective To investigate the impact of ultrapure dialysate on long-term survival rate and complication in maintenance hemodialysis patients.Methods Seventy maintenance hemodialysis patients were selected,and they were divided into ultrapure dialysate group (36 cases) and control group (34 cases) by random digits table method.The 1-,3-,5-year mortality,death causes and the incidences of cardiovascular complication,infection,cerebrovascular accident were recorded.Results The 3-and 5-year mortality in ultrapure dialysate group were significantly lower than those in control group:30.6％ (11/36) vs.41.2％ (14/34) and 41.7％ (15/36) vs.82.4％ (28/34),and there were statistical differences (P ＜ 0.05).The mortality of infection in ultrapure dialysate group was significantly lower than that in control group:1/15 vs.21.4％ (6/28),and there was statistical difference (P ＜ 0.05).The incidences of cardiovascular complication,cerebrovascular accident,infection in ultrapure dialysate group were significantly lower than those in control group:47.2％ (17/36) vs.79.4％ (27/34),27.8％ (10/36) vs.41.2％ (14/34) and 41.7％ (15/36) vs.73.5％ (25/34),and there were statistical differences (P ＜ 0.05).Conclusion Ultrapure dialysate can increase long-term survival rate and decrease incidence of complication in maintenance hemodialysis patients.
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Objectives To study the efficacy of the two-compartment peritoneal dialysis fluid with low glucose degradation products in peritoneal dialysis (PD) patients.Methods Pubmed,EBMASE,Cochrane Library,Wanfang,VIP,CNKI,CBM and other databases were searched,at the same time the information form relevant literatures until December 2013 were searched by hand.To be eligible,studies had to be randomized controlled trials that allocated PD patients to two-compartment peritoneal dialysis fluid with low glucose degradation products (low-GPDs group) or to traditional dialysis fluid (control group).The qualities of included articles were assessed and then a meta-analysis was conducted by using RevMan 5.2 software.Results A total of 12 documents,11 studies met the inclusion criteria,and 1 059 cases were included.Meta-analysis results were as follows:(1)the low-GPDs group had higher level of CA125 in peritoneal dialysis effluent,higher residual renal function compared with that in the control group and the weighted mean difference were 19.61 (95％CI 12.04-27.18,P ＜ 0.01) and 0.78 (0.14-1.43,P=0.02),respectively; (2)There was no statistically significant difference between control and low-GPDs group in the ultrafiltration,peritonitis and plasma bicarbonate (all P ＞ 0.05); (3)Four studies showed no difference in peritoneal dialysis technique survival between the two group (P ＞ 0.05).Conclusions The two-compartment peritoneal dialysis fluid with low glucose degradation products is effective and safe,has no negative effects on the frequency of peritonitis,patient' s peritoneal member transport function and plasma bicarbonate,but it causes less mesothelial damage and has higher residual renal function in patients than conventional ones,and does not affect the technique survival time.
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This retrospective study was performed to determine the ranges of the sodium gradient (SG) between the dialysate sodium concentration (DNa) and serum sodium concentration (SNa) in hemodialysis (HD) patients and to examine the relationships between HD parameters over a 1 year period. Fifty-five clinically stable HD patients, who had been on HD >2 years were enrolled. Monthly HD [ultrafiltration (UF) amount, systolic blood pressure (SBP), frequency of intradialytic hypotension (IDH)] and laboratory data were collected and 12-month means were subjected to analysis. The SG was calculated by subtracting SNa from prescribed DNa. Mean SG values were 1.5+/-3.3 (range -5.6~9.1). SG was positively related to DNa and the frequency of IDH. A higher SG was associated with larger UF amounts and SBP reduction during HD. The percentages of patients with a SG > or =3mEq/L increased as DNa increased. On the other hand, SG was not found to be associated with SNa or pre-HD SBP. DNa appears to cause a significant increase in SG, and this seems to be related to HD parameters, such as, UF amount and IDH.
Subject(s)
Humans , Blood Pressure , Dialysis Solutions , DNA , Hand , Hypotension , Renal Dialysis , Retrospective Studies , SodiumABSTRACT
Objective To explore the effect and mechanism of fluvastatin on the expression of fibronectin(FN) in human peritoneal mesothelial cells (HPMCs) induced by high-glucose peritoneal dialysate (HGPDS).Methods Cultured HPMCs were randomly divided into control,HGPDS,HGPDS plus GSK650394 10-5 mol/L (the competitive inhibitor of SGK1),different concentrations of fluvastatin,fluvastatin 10-6 mol/L and GSK650394 10-5 mol/L alone.The morphology change of HPMC was observed by light microscopy.The cellular viability was detected by MTT colorimetry.The mRNA and protein expressions of serum and glucocorticoid-inducible kinase 1 (SGK1) and FN were detected by RT-PCR,Western blotting or ELISA.Results After incubation with HGPDS,the cell morphology changed from typical cobblestone-like appearance to fibroblast-like appearance,and the cell viability was inhibited significantly (P＜0.05).Fluvastatin 10-6mol/L and GSK650394 could improved the cell morphology and the cell viability injured by HGPDS (P＜0.05).Compared with the normal control group,the mRNA and protein expressions of SGK1 and FN increased significantly in HPMC treated with HGPDS(P＜0.05).GSK650394 significantly decreased the high expression of SGK1 and FN (P＜0.05),also the fluvastatin had same effects as GSK650394 in dose-dependent manner (P＜0.05).Conclusions High-glucose peritoneal dialysate can increase FN expression in human peritoneal mesothelial cells,which can be attenuated by fluvastatin.The protective role of fluvastatin in HPMC may be partially achieved through the signal pathway of SGK1.
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Objective To analyze the dialysis adequacy of the maintenance hemodialysis patients under different dialyzate flow.Methods Forty-eight patients under maintenance hemodialysis were divided into four groups according to dialyzate flow:500 ml/min group,600 ml/min group,700 ml/min group and 800 ml/min group,with 12 patients in each group.Each group was treated 6 weeks.The albumin (Alb),hemoglobin(Hb),hematocrit(Hct),blood urea nitrogen (BUN),serum creatinine(SCr) and parathyroid hormone(iPTH) levels before and after treatment were examined,Kt/V and urea reduction ratio(URR) were calculated separately.Results There was no significant difference in Kt/V between 500 ml/min group and 600 ml/min group.Kt/V was no increased when the dialyzate flow rate increased from 500 ml/min to 600 ml/min,that was to say they could not improve the dialysis adequacy.There was statistically significant difference in Kt/V among 500 ml/min group,600 ml/min group,700 ml/min group and 800 ml/min group,and 800 ml/min group on the dialysis adequacy was better.Different dialyzate flow on the impact of the dialysis adequacy was compared in self-control method.Kt/V increased along with the increase of dialyzate flow,and the dialysis adequacy and dialyzate flow showed positive correlation.Conclusion The high dialyzate flow of dialysis treatment can improve Kt/V and has significant effect in enhancing the dialysis adequacy.
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BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis. METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A. RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 +/- 1.0 to 9.0 +/- 0.7, p = 0.002 vs. 1.3 +/- 0.1 to 1.1 +/- 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 +/- 45.8 pmol/mL at baseline to 124.9 +/- 82.2 pmol/mL at 6 months, p = 0.043). CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Analysis of Variance , Ankle Brachial Index , Arteries/drug effects , Biomarkers/blood , Blood Pressure/drug effects , Calcium/administration & dosage , Compliance , Hemodialysis Solutions/administration & dosage , Prospective Studies , Pulsatile Flow/drug effects , Renal Dialysis , Republic of Korea , Time Factors , Treatment Outcome , alpha-2-HS-Glycoprotein/metabolismABSTRACT
INTRODUÇÃO/OBJETIVO: A doença óssea adinâmica (DOA) é um achado comum em diálise peritoneal (PD) e é considerada fator de risco para desenvolvimento de fraturas e doença cardiovascular. Dados do BRAZPD apontam as soluções de cálcio a 3,5 mEq/L presentes na maioria das prescrições no país, que possui quase 9.000 pacientes em PD. É comum o balanço positivo de cálcio com concentrações a 3,5 mEq/L contribuindo para o desenvolvimento de DOA. Diretrizes atuais recomendam um PTHi na DRC V em diálise entre 2 e 9 vezes (150-500 pg/mL) o valor máximo da normalidade. O objetivo deste estudo foi avaliar a resposta em 6 meses do PTH-i após a conversão para solução de cálcio a 2,5 mEq/L de pacientes que usavam soluções com cálcio a 3,5 mEq/L e com PTH-i basal < 150 pg/mL. MÉTODOS: Coorte prospectiva, observacional, na qual todos pacientes prevalentes em PD entre janeiro de 2008 e janeiro de 2009 de um único centro foram incluídos. Critérios de inclusão foram:(1) estar em uso de solução de DP com cálcio a 3,5 mEq/L; (2)PTH sérico < 150 pg/mL. A critério médico, os pacientes poderiam ser convertidos ou não para soluções cálcio a 2,5 mEq/L. RESULTADOS: 35 pacientes (idade média 62 ± 17 anos) foram incluídos. Desses, 22 foram convertidos para solução de cálcio 2,5 mEq/L. Nefropatia diabética foi a principal doença de base (36 por cento) seguido por HAS (25 por cento) e GNC (14 por cento). Os grupos apresentavam valores basais semelhantes de PTH, cálcio, fósforo e fosfatase alcalina. No grupo-intervenção, houve aumento significativamente maior de PTH em 6 meses comparado com o grupo-controle (Δ194 pg/dL versus Δ 92/dL; p < 0,05).
INTRODUCTION/OBJECTIVE: Adinamic bone disease (ABD) is a common finding in peritoneal dialysis (PD) and is associated with higher risk of developing cardiovascular and bone disease. Data from BRAZPD indicates that 3.5 mEq/L calcium PD solutions represents the majority of PD prescriptions in the country. A positive calcium balance can contribute to ABD development. Currently guidelines suggest that PTH-i levels in end stage renal disease should be kept from 150-300 pg/mL. The purpose of this study is to evaluate 6 month PTH-i response after conversion to 2.5 mEq/L calcium PD solution in patients with baseline PTH-i levels < 150 pg/mL. METHODS: Prospective, observational study of all prevalent patients (at least 90 days on therapy) on PD of a single Brazilian center from January 2008 to May 2009. Inclusion criteria (1) be in use of a PD solution with 3.5mEq/L of calcium; (2) baseline PTH leves < 150 pg/ mL. According to clinical practice patients could be switched to PD solutions with 2.5 mEq/L of calcium. RESULTS: 35 patients (age 62 ± 17 years) were included. Of these 22 were converted to 2.5 mEq/L calcium solutions. Diabetic nephropathy (36 percent) was the main cause of renal disease followed by nephrosclerosis (25 percent) and glomerulonephritis (14 percent). Converted group presented a greater increase in PTH levels when compared with the control group (Δ194 pg/dL versus Δ 92/dL; p < 0,05). Among patients switched to low calcium solution, 41 percent reached the target values (PTH 150300 pg/mL) compared to 14 percent whose remain with normal calcium solutions (p < 0.05). There were no differences between groups regarding calcium, phosphorus and alkaline phosphatase. CONCLUSION: In patients with PTH < 150 pg/mL conversion to low calcium solutions (2.5 mEq/L) appears to be a simple and effective strategy to bring PTH levels to the range determined by current guidelines when compared with 3.5mEq/L calcium PD solutions.
Subject(s)
Humans , Male , Female , Middle Aged , Calcium/therapeutic use , Peritoneal Dialysis , Parathyroid Hormone/analysis , Dialysis Solutions/therapeutic useABSTRACT
Objective To investigate the role of Notch signaling in the progression of peritoneal fibrosis in a rat model induced by high glucose dialysate. Methods Male Sprague Dawley rats were subjected to daily peritoneal dialysis (PD) with a lactate-buffered solution containing 4.25% glucose. They were sacrificed at 2 and 4 weeks after PD. The parietal thickness was measured with Masson staining. The expression of TGF-β1, E-cadherin, α-SMA and collagen Ⅰ was examined by immunoblotting. The expression of Notch ligand Jagged-1 and the negative Notch signaling regulato--Numb was analyzed by both immunoblotting and RT-PCR. The expression of a Notch nuclear target gene Hcs-1 was examined by RT-PCR. Results Both HE and Masson trichrome staining revealed an increase in peritoneal thickness with a loss of mesothelial cells and a rich of collagen matrix deposition in the submesothelial zone was evident at 4 weeks after PD. Meanwhile, compared to healthy rats, the expression of TGF-β1, ct-SMA and collagen Ⅰ was significantly increased, but the expression of E-cadherin was decreased in peritoneum after PD treatment. It was difficult to detect the Jagged-1 and Hes-1 expression in normal peritoneum, but their expression was graduaUy increased after PD. In contrast, the expression level of Numb, a negative regulator of Notch signaling, was dramatically decreased after PD. Conclusions Notch signaling is activated during the process of PD-induced peritoneal fibrosis and the activation of Notch signaling is associated with the loss of negative regulation of Notch signaling via decreased expression of Numb. Inhibition of Notch signaling via overexpression of its negative regulators such as Numb may be a novel therapeutic approach for peritoneal fibrosis in PD patients.
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Objective To discuss the effects of peritoneal dialysate (PDS) on the expression of aquaporin-1 in rat peritoneal mesothelial cells (RPMCs). Methods The in vitro cultured RPMCs were divided randomly into 4 groups, and stimulated respectively with 1640 culture medium containing 10% fetal calf serum (negative control), and three kinds of PDS (containing respectively 4.25% glucose, 4.25% mannitol or 1.5% glucose) for 3 hours. Indirect immunofluorescence assay (IFA) and flow cytometry (FCM)were employed to detect the expression of aquaporin-1 in RPMCs stimulated by different kind of PDS as above. Results Compared with negative control and the group with PDS containing 1.5% glucose, the expression of aquaporin-1 on the mesothelial cells of the group with PDS containing 4.25% glucose and that containing 4.25% mannitol was significantly up-regulated (P0.05). Conclusion PDS with higher osmotic pressure (OP) can enhance the expression of aquaporin-1 in RPMCs. For PDS with same OP (PDS containing 4.25% glucose or PDS containing 4.25% mannitol), those containing glucose can enhance the expression of aquaporin-1 more effectively than that PDS containing mannitol. This result indicates that glucose or its degradation products may be the independent factors in enhancing the expression of aquaporin-1 of RPMCs.