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Abstract
Peritoneal dialysis (PD) has attained increased relevance as continuous renal replacement therapy over the past years. During this treatment, the peritoneum functions as dialysis membrane to eliminate diffusible waste products from the blood-stream. Success and efficacy of this treatment is dependent on the integrity of the peritoneal membrane. Chronic inflammatory conditions within the peritoneal cavity coincide with elevated levels of proinflammatory cytokines leading to the impairment of tissue integrity. High glucose concentrations and glucose metabolites in PD solutions contribute to structural and functional reorganization processes of the peritoneal membrane during long-term PD. The subsequent loss of ultrafiltration is causal for the treatment failure over time. It was shown that peritoneal mesothelial cells are functionally connected via Nanotubes (NTs) and that a correlation of NT-occurrence and defined pathophysiological conditions exists. Additionally, an important participation of NTs during inflammatory reactions was shown. Here, we will summarize recent developments of NT-related research and provide new insights into NT-mediated cellular interactions under physiological as well as pathophysiological conditions.
Highlights
SECTION Peritoneal dialysis (PD) is an accepted alternative to hemodialysis in the treatment of end-stage renal disease
The heat sterilization leads to the formation of glucose degradation products (GDPs) (Wieslander et al, 1995) which mainly contribute to the formation of advanced glycation endproducts (AGEs) including methylglyoxal (MG) (Nakayama et al, 1997; Muller-Krebs et al, 2008)
A strong induction of the expression of the receptor for advanced glycation end-products (RAGE) in the peritoneal membrane of uremic patients was demonstrated which further increased after PD treatment (Kihm et al, 2008), showing AGERAGE interactions being crucial in peritoneal damage due to inflammatory conditions, uremia, and PD
Summary
SECTION Peritoneal dialysis (PD) is an accepted alternative to hemodialysis in the treatment of end-stage renal disease. The implantation and presence of an indwelling catheter, high glucose concentrations, and GDPs in the dialysis solutions as well as peritonitis - a known complication of PD - coincide with high levels of proinflammatory cytokines within the peritoneal cavity and subsequent induce chronic inflammatory conditions leading to structural and functional changes of the peritoneal membrane (Witowski et al, 2000; Flessner et al, 2007, 2010).
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