Novel ways to preserve the peritoneal membrane

The underlying pathophysiology that leads to morphologic and functional changes in the peritoneal membrane over time among patients on peritoneal dialysis is not well understood. Many studies have been conducted to try to abrogate those changes and so preserve peritoneal function. Conventional interventions that attempt to accomplish that end include prevention of peritonitis, timely removal of the peritoneal catheter in the face of non-resolving peritonitis, use of biocompatible dialysate, and limitation of total glucose exposure by avoiding hypertonic dextrose solutions. Inhibition of the renin-angiotensin-aldosterone and vascular endothelial growth factor systems, peritoneal resting, combined peritoneal dialysis and hemodialysis, and N-acetylcysteine and gene therapy are more novel and experimental attempts to preserve the peritoneal membrane. We review the novel studies that have aimed to promote the health and function of this dialyzing membrane.