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  • Review Article
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Peritoneal changes in patients on long-term peritoneal dialysis

Nature Reviews Nephrology volume 9, pages 419–429 (2013)Cite this article

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Abstract

Long-term peritoneal dialysis can lead to morphological and functional changes in the peritoneum. Although the range of morphological alterations is known for the peritoneal dialysis population as a whole, these changes will not occur in every patient in the same sequence and to the same extent. Longitudinal studies are therefore required to help identify which patients might develop the changes. Although longitudinal studies using peritoneal biopsies are not possible, analyses of peritoneal effluent biomarkers that represent morphological alterations could provide insight. Longitudinal studies on peritoneal transport have been performed, but follow-up has often been too short and an insufficient number of parameters have been investigated. This Review will firstly describe peritoneal morphology and structure and will then focus on peritoneal effluent biomarkers and their changes over time. Net ultrafiltration will also be discussed together with the transport of small solutes. Data on the peritoneal transport of serum proteins show that serum protein levels do not increase to the same extent as levels of small solutes with long-term peritoneal dialysis. Early alterations in peritoneal transport must be distinguished from alterations that only develop with long-term peritoneal dialysis. Early alterations are related to vasoactive mediators, whereas later alterations are related to neoangiogenesis and fibrosis. Modern peritoneal dialysis should focus on the early detection of long-term membrane alterations by biomarkers—such as cancer antigen 125, interleukin-6 and plasminogen activator inhibitor 1—and the improved assessment of peritoneal transport.

Key Points

  • Studies have provided information regarding peritoneal morphological changes occurring with long-term peritoneal dialysis on a population scale, but this information cannot be used to identify changes occurring in individual patients

  • Longitudinal studies—investigating peritoneal effluent biomarkers and peritoneal fluid and solute transport—are required to investigate the development of alterations in individual patients

  • Promising biomarkers include cancer antigen 125, interleukin-6 and plasminogen activator inhibitor 1

  • Early ultrafiltration failure is often reversible and is usually associated with fast transport rates of low molecular weight solutes, which result in a rapid disappearance of the osmotic gradient

  • Long-term ultrafiltration failure develops over time and is often characterized by impaired osmotic conductance to glucose and reduced free water transport; in the absence of residual urine production, it can easily lead to overhydration

  • Peritoneal clearances of serum proteins increase less with peritoneal dialysis duration than do clearances of small solutes

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  1. Division of Nephrology, Department of Medicine, Academic Medical Centre Meibergdreef 9, University of Amsterdam, Amsterdam, 1105 AZ, the Netherlands

    Raymond T. Krediet & Dirk G. Struijk

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Krediet, R., Struijk, D. Peritoneal changes in patients on long-term peritoneal dialysis. Nat Rev Nephrol 9, 419–429 (2013). https://doi.org/10.1038/nrneph.2013.99

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