Protecting the peritoneal membrane in dialyzed patients

This review paper describes methods of protecting the peritoneal membrane in uremic patients chronically treated with peritoneal dialysis. Possible interventions involved in protection of the peritoneum aim at reducing peritoneal exposure to glucose, glucose degradation products and lactate; preventing or diminishing harmful effects of dialysis solutions; decreasing infection rate, especially peritonitis, and its consequences. Techniques reducing peritoneal exposure to bioincompatible solutions include peritoneal resting, replacing some glucose exchanges with amino acid-based, icodextrin-based or glycerol-based dialysis solution, using bicarbonate or pyruvate as a buffer, and administering solutions with low content of glucose degradation products. Preventing or diminishing harmful effects of dialysis solutions includes interventions with drugs, especially those given intraperitoneally. Decreasing local and systemic infection rate is also very or even the most important in maintaining relatively unchanged peritoneal membrane histology and function.