Breaking barriers in peritoneal fibrosis: extracellular vesicles as promising diagnostic and therapeutic strategy

Peritoneal dialysis is an essential therapy for end-stage kidney disease, but its long-term efficacy is severely limited by peritoneal fibrosis. Driven by mesothelial-mesenchymal transition, inflammation and angiogenesis, this pathological process leads to treatment failure and increased mortality. The urgent need for effective therapies has shifted research focus to extracellular vesicles-phospholipid bilayer nanovesicles that shuttle bioactive cargoes to modulate pathogenic pathways, positioning them as key mediators in peritoneal fibrosis.

This review synthesises preclinical evidence to evaluate the dual diagnostic and therapeutic potential of extracellular vesicles. By analysing their cellular sources and regulatory roles in fibrotic pathways, we highlight their promise as both non-invasive biomarkers and targeted therapeutic agents for peritoneal fibrosis. It further integrates these mechanistic insights with critical translational hurdles, including unstandardised technical preparation, unclear in vivo biodynamics and unconfirmed long-term safety in clinical translation.

Extracellular vesicles hold great potential as novel non-invasive biomarkers and targeted therapeutic agents for peritoneal fibrosis. This review outlines a developmental roadmap for extracellular vesicles-based strategies by combining mechanistic findings with translational challenges. Addressing these critical gaps will be pivotal to unlocking the clinical value of extracellular vesicles, preserving peritoneal membrane function and improving long-term outcomes for relevant patients.