Preservation of Peritoneal Membrane Structure and Function in Peritoneal Dialysis

Peritoneal dialysis (PD) is a type of renal replacement therapy which is based on the use of peritoneum, which acts as a semipermeable membrane with diffusion and convection. Long term use can produce structural and functional changes of the membrane by the activation of the resident fibroblasts and infiltrating inflammatory cells, mesothelial to mesenchymal transition, further leading to fibrosis, angiogenesis and ultrafiltration failure. This is due to use of bioincompatible fluids, frequent peritoneal inflammation, uremic milieu and other multiple factors. The peritoneal fibrosis has two parts: fibrosis and inflammation, which induces each other via TGF/SMAD pathway and IL-6 signaling, respectively. The advent of newer biocompatible fluids along with additives has significantly reduced the production of glucose degradation products (GDPs). In addition, the identification of the biomarkers in peritoneal effluent is necessary, which, after being correlated with peritoneal biopsy, may help us to guide future studies and assessment of the efficacy of therapeutic interventions. Various interventions are being tried based on experimental studies from animal models, pharmacology and gene therapy with promising results, with new insights in near future. This article reviews the main aspects associated with the functional and structural alterations related to PD and discusses interventions whereby we may prevent them to preserve the peritoneal membrane