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Peritoneal changes in patients on long-term peritoneal dialysis
Raymond T Krediet1, Dirk G Struijk
1Division of Nephrology, Department of Medicine, Academic Medical Centre Meibergdreef 9, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands. r.t.krediet@amc.uva.nl
Nature Reviews. Nephrology
|May 15, 2013
Summary
Long-term peritoneal dialysis causes changes in the peritoneum. Monitoring peritoneal effluent biomarkers like cancer antigen 125 can help detect these long-term membrane alterations early.
Area of Science:
- Nephrology
- Cell Biology
- Biomarker Research
Background:
- Long-term peritoneal dialysis (PD) can induce significant morphological and functional changes in the peritoneum.
- These peritoneal alterations vary in sequence and severity among patients, necessitating longitudinal monitoring.
Purpose of the Study:
- To review peritoneal morphology and structure in the context of PD.
- To explore the utility of peritoneal effluent biomarkers for tracking longitudinal changes in PD patients.
- To differentiate early PD-induced alterations from those developing over the long term.
Main Methods:
- Review of existing literature on peritoneal dialysis, morphology, and transport.
- Analysis of peritoneal effluent biomarkers (e.g., cancer antigen 125, interleukin-6, plasminogen activator inhibitor 1).
- Discussion of peritoneal transport of small solutes and serum proteins, net ultrafiltration, and neoangiogenesis/fibrosis.
Main Results:
- Long-term PD is associated with peritoneal structural and functional changes.
- Peritoneal effluent biomarkers offer a non-invasive method to assess these changes over time.
- Serum protein levels do not increase proportionally to small solute levels with long-term PD.
Conclusions:
- Early PD-related peritoneal alterations are linked to vasoactive mediators, while later changes involve neoangiogenesis and fibrosis.
- Early detection of long-term peritoneal membrane alterations using biomarkers is crucial for modern PD management.
- Improved assessment of peritoneal transport dynamics is essential alongside biomarker monitoring.
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