Hidden Impacts of Peritoneal Dialysis on the Endocrine System

Peritoneal dialysis (PD) is a widely used renal replacement therapy in which hyperosmolar solutions are instilled into the abdominal cavity to facilitate the removal of excess water, electrolytes, and metabolic waste products. During PD treatment, homeostasis is maintained through adaptive responses of the neuroendocrine system to high glucose exposure, changes in circulating blood volume, and shifts in electrolyte balance. Clinical observations and limited experimental studies suggest that these neurohormonal dynamics may influence both the complications and therapeutic efficacy of PD. However, systematic investigations remain scarce, largely because hormonal and neural responses are highly dynamic, involve complex interactions, and are substantially influenced by individual patient characteristics. In this review, we synthesize current clinical and experimental evidence linking PD-related complications with hidden hormone dynamics, with particular emphasis on hypothalamic hormones such as arginine vasopressin. We also discuss how the biocompatibility of PD solutions-traditionally assessed by their effects on peritoneal mesothelial cells-could be reconsidered when neuroendocrine aspects are taken into account. We propose that integrating both clinical insights and emerging basic research will provide a more comprehensive understanding of neuroendocrine regulation in PD and may contribute to the development of novel therapeutic strategies.