Molecular Mechanisms of Peritoneal Permeability— Research in Growth Factors

eritoneal dialysis (PD) is now an established treatment of end-stage renal failure, used in approximately 15% of dialysis patients worldwide. Over the past few years, the morbidity associated with acute peritonitis has been considerably reduced (1). The major problem remaining with long-term PD is the high incidence of ultrafiltration (UF) failure, which can affect up to 50% of PD patients treated for more than 6 years (2,3). Cross-sectional and longitudinal studies have shown that peritoneal solute transport increases with time on PD (4). This increased permeability for small solutes means faster absorption of glucose, early dissipation of the osmotic gradient, and, eventually, UF failure (5). The relevance of the modifications in the peritoneal membrane is illustrated by the fact that high peritoneal membrane permeability is a significant risk factor for PD patients, predicting both technical failure and patient death (6). This brief review discusses how structural, functional, and molecular data have improved our understanding of the modifications to the peritoneal membrane in long-term PD. STRUCTURAL MODIFICATIONS TO THE PERITONEUM