Sterile solutions and peritoneal inflammation.
There is now abundant evidence in both animal and human studies that sterile dialysis solutions result in the alteration of the peritoneal barrier. Mesothelial cells undergo an epithelialto- mesenchymal transition after less than 1 year of dialysis. After more than 6 years of peritoneal dialysis, there is extensive fibrosis and neoangiogenesis in the sub-mesothelial compact zone. Clinical studies demonstrate that the structural changes correlate with alterations in transport function and progressive ultrafiltration failure. The mechanisms of inflammation include cellular peroxide production, acidic solutions, glucose and its degradation products, and the integrated response of the cellular-cytokine cascade. Basic and translational research efforts are discussed to highlight our current knowledge in this area and the remaining questions.
Flessner
Michael F
MF
Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Miss., USA.
D015314:Dialysis Solutions / Q000009:adverse effects*; D004847:Epithelial Cells / Q000473:pathology; D005947:Glucose / Q000378:metabolism; D006801:Humans; D015850:Interleukin-6 / Q000235:genetics; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010537:Peritoneum / Q000378:metabolism / Q000473:pathology; D010538:Peritonitis / Q000209:etiology*
D015314:Dialysis Solutions; D015850:Interleukin-6; D005947:Glucose