Peritoneal fibrosis (PF) is an important complication of long-term
peritoneal dialysis. Although
mineralocorticoid and
mineralocorticoid receptor (MR) have attracted increasing attention in the field of
vascular injury, including the heart, kidney, and vessels, little is known about the role of
mineralocorticoid in PF. This work was designed to explore the effects of MR blockade on PF. We developed a new model of PF in rats based on mechanical scraping of the peritoneum. This model is characterized by acute-phase
inflammation (neutrophil and macrophage infiltration on days 0-3) and late-phase PF (alpha-smooth muscle actin-positive fibroblast infiltration,
type III collagen accumulation, and neoangiogenesis on days 7-14). Peritoneal thickening peaked on day 14. MR was expressed in rat peritoneum and a rat fibroblast cell line. Expression of its effector
kinase [serum- and
glucocorticoid-induced kinase-1 (Sgk1)],
transforming growth factor-beta (
TGF-beta),
plasminogen activator inhibitor-1 (PAI-1), and CD31-positive vessels increased during the course of PF. Rats were treated with
spironolactone,
angiotensin receptor blockade (ARB), or
angiotensin-converting enzyme inhibitor (ACEI)-ARB-
spironolactone starting at 6 h after peritoneal scraping. All parameters, including peritoneal thickening, number of macrophages and CD31-positive vessels, and expression of
monocyte chemoattractant protein-1,
TGF-beta,
PAI-1, and Sgk1, were significantly suppressed by
spironolactone (10 mg x kg(-1) x day(-1)). The effects of
spironolactone (10 and 20 mg x kg(-1) x day(-1)) were very similar to those of triple blockade. ARB, but not ACEI, significantly reduced peritoneal thickening. Furthermore, peritoneal function assessed by peritoneal equilibration test was significantly improved by
spironolactone. Our results suggest that MR is a potential target to prevent
inflammation-induced PF in patients on
peritoneal dialysis.