| [ Summary ] |
During long term continuous ambulatory peritoneal dialysis (CAPD) treatment, the peritoneal membrane undergoes structural as well as functional alterations. The main feature of peritoneal morphologic changes is peritoneal sclerosis, including a loss of mesothelial cells, submesothelial thickening and increased vascularization with vasculopathy. These alterations result in decreased dialysis efficiency, leading to CAPD treatment failure.
Peritoneal sclerosis has been associated with repeated infections or exposure to unphysiologically high glucose concentrations and low pH dialysate. It may lead to the activation of peritoneal macrophages. These activated macrophages initiate the cytokine network with other types of cells in the peritoneum, such as mesothelial cells and vascular endothelial cells. Amplification of the cytokine network increases the potential for intraperitoneal generation of factors that enhance proliferative and fibrotic activities, such as IL-1, IL-6, TGF-β and VEGF. Consequently, there is a proliferation of fibroblasts and excess production of collagen, which leads to peritoneal sclerosis, occurring in the peritoneal cavity. It is therefore suggested that strategies for the prevention of peritoneal sclerosis should target intraperitoneal cytokines. Further studies of peritoneal sclerosis, related to CAPD are warranted. |