International Pediatric Peritoneal Biopsy Study

Within few years the peritoneal membrane of adult peritoneal dialysis (PD) patients undergoes
substantial morphological transformation, including progressive fibrosis, vasculopathy and
neoangiogenesis. Ultrafiltration capacity steadily declines and ultimately results in PD
failure. In children, peritoneal biopsies demonstrating PD associated alterations have not
yet been obtained. They, however, should be particularly informative, since secondary tissue
and vascular pathology related to ageing or diabetes is absent.

An international, prospective peritoneal membrane biopsy study in children on PD will
therefore be performed. Biopsies will be obtained at time of PD catheter insertion, on
occasion of intercurrent abdominal surgery (e.g. hernia repair, catheter exchange) and at
time of renal transplantation. Quantitative histomorphometry and tissue protein expression
analyses will be correlated with time integrated PD treatment modalities and functional
characteristics as well as inflammatory and cardiovascular comorbidity surrogate parameter.
Blood will be obtained during clinical routine sampling. Biopsies will be obtained during
clinically indicated operations, without substantially increasing operation time and
associated surgical risks. The detailed histomorphometry of the PD membrane will give
additional information, potentially impacting on the individual PD regime.