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  • Review Article
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Protecting the peritoneal membrane: factors beyond peritoneal dialysis solutions

Nature Reviews Nephrology volume 8, pages 542–550 (2012)Cite this article

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Abstract

Functional deterioration of the peritoneal membrane in patients on peritoneal dialysis has been described as being the result of a combination of neoangiogenesis and fibrosis. Glucose, glucose degradation products, and the unphysiological pH of the dialysate solution contribute to these changes. Although newer solutions clearly perform better in terms of their biocompatibility in an in vitro setting and in animal models, the benefit of such solutions over older solutions in the clinical setting is so far unproven. The difficulties in showing a benefit of the newer, more biocompatible solutions in the clinical setting can be explained by the fact that other factors also affect the properties of the peritoneal membrane. These factors are often neglected in clinical studies, which results in unnoticed differences in case-mix and blurs the potential impact of the novel solutions. However, many of these factors are modifiable, and attention should be paid to them in clinical practice to maintain the integrity of the peritoneal membrane. This Review focuses on factors that potentially influence the integrity of the peritoneal membrane, other than those associated with the peritoneal dialysis fluid itself.

Key Points

  • Factors other than those related to the peritoneal dialysis fluid can have important effects on the peritoneal membrane, and can result in variability in peritoneal function

  • The degree of glycaemic control rather than diabetes per se can cause changes to the peritoneal membrane; studies should therefore use haemoglobin A1c level instead of the dichotomized classification of diabetes/no diabetes

  • A high salt intake can induce changes in the peritoneal membrane by inducing hypertonic exchanges and by directly inducing peritoneal membrane changes

  • Peritoneal membrane characteristics can be influenced by genetic polymorphisms; further exploration of genetic polymorphisms in patients with encapsulating peritoneal sclerosis are warranted

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Figure 1: Simplified schematic showing factors, other than PD fluid, that potentially influence peritoneal membrane degradation.

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  1. Renal Division 0K12IA, Ghent University Hospital, De Pintelaan, Ghent, 185, 9000, Belgium

    Anneleen Pletinck, Raymond Vanholder, Nic Veys & Wim Van Biesen

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  1. Anneleen Pletinck
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A. Pletinck and W. Van Biesen researched data for the article, made a substantial contribution to discussion of content, wrote the article, and reviewed/edited the manuscript before submission. R. Vanholder and N. Veys made a substantial contribution to discussion of content and were involved in the review/editing of manuscript before submission.

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Correspondence to Wim Van Biesen.

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The authors' laboratory has received unrestricted grants from Baxter and Fresenius for basic scientific research. Wim Van Biesen has received honoraria from Baxter, Fresenius and Gambro. Raymond Vanholder has received honoraria from Fresenius and is a consultant for Baxter.

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Pletinck, A., Vanholder, R., Veys, N. et al. Protecting the peritoneal membrane: factors beyond peritoneal dialysis solutions. Nat Rev Nephrol 8, 542–550 (2012). https://doi.org/10.1038/nrneph.2012.144

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