Abstract
Peritoneal dialysis (PD) is a cost-effective, home-based therapy for patients with end-stage renal disease achieving similar outcome as compared to hemodialysis. Still, a minority of patients only receive PD. To a significant extend, this discrepancy is explained by major limitations regarding PD efficiency and sustainability. Due to highly unphysiological composition of PD fluids, the peritoneal membrane undergoes rapid morphological and long-term functional alterations, which limit the treatment and contribute to adverse patient outcome. This review is focused on the peritoneal membrane ultrastructure and its transformation in patients with kidney disease and chronic PD, underlying molecular mechanisms, and potential systemic sequelae. Current knowledge on the impact of conventional and second-generation PD fluids is described; novel strategies and innovative PD fluid types are discussed.
Highlights
Introduction of neutralpH, low glucose degradation products (GDP) fluids raised hope to prevent long-term deterioration of the peritoneal membrane, based on numerous in vitro and experimental in vivo studies
This review focuses on the usage of the semipermeable peritoneum as a biological dialysis membrane, its transformation with peritoneal dialysis (PD), and current concepts and future prospects to improve PD efficacy and sustainability
While superior residual renal function during the first year of PD may be related to less-effective fluid removal and consequent volume expansion with neutral pH, low GDP fluid, the long-term effect could be related to lower renal GDP and advanced glycation end products (AGE) exposure (Cho et al, 2014; Yohanna et al, 2015)
Summary
Reviewed by: Ramon Paniagua, Instituto Mexicano del Seguro Social (IMSS), Mexico Miguel Perez Fontan, University of A Coruña, Spain. Biocompatible Peritoneal Dialysis: The Target Is Still Way Off. Front. Peritoneal dialysis (PD) is a cost-effective, home-based therapy for patients with end-stage renal disease achieving similar outcome as compared to hemodialysis. A minority of patients only receive PD. This discrepancy is explained by major limitations regarding PD efficiency and sustainability. Due to highly unphysiological composition of PD fluids, the peritoneal membrane undergoes rapid morphological and long-term functional alterations, which limit the treatment and contribute to adverse patient outcome. This review is focused on the peritoneal membrane ultrastructure and its transformation in patients with kidney disease and chronic PD, underlying molecular mechanisms, and potential systemic sequelae.
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