Serial ultrafine endoscopic assessment of fibrin deposition and neomembrane formation in peritoneal dialysis patients using low glucose degradation product fluid

Preservation of the peritoneum is essential for the safe continuation of peritoneal dialysis (PD). Although PD fluid with low glucose degradation products (low GDP) are widely used, objective macroscopic assessment of the peritoneum during ongoing PD remains limited. We therefore performed serial ultrafine endoscopic assessment to evaluate peritoneal status in patients receiving PD. Sixty outpatients undergoing PD with low GDP PD fluid underwent ultrafine endoscopic assessment. Serial examinations were performed in 49 patients after 12 months. Peritoneal findings, including fibrin deposition, neomembrane formation, and microvasculature abnormalities, were assessed using prespecified criteria through a blinded, multistep adjudication process based on endoscopic video recordings. All examinations were completed safely in the outpatient setting without anesthesia or procedure-related adverse events. Fibrin adhesion within the catheter lumen was observed in 87% of patients. The peritoneal surface was uniformly smooth, and macroscopic abnormalities were generally mild and localized, consisting mainly of fibrin deposition (46% of parietal and 52% of visceral peritoneum) and neomembrane formation (21% and 48%, respectively), with limited microvascular abnormalities (21% and 16%, respectively). These findings were not significantly associated with PD vintage. Over 12 months, both the appearance and disappearance of these findings were observed, without a consistent directional pattern. Serial ultrafine endoscopic peritoneal assessments were safely feasible during the course of PD. Fibrin deposition and neomembrane formation were the predominant macroscopic findings and were not significantly associated with PD duration in patients treated with low GDP PD fluid. Clinical Trials Registry : UMIN000051610