title: Protecting the peritoneal membrane: factors beyond peritoneal dialysis solutions.
abstract: Functional deterioration of the peritoneal membrane in patients on peritoneal dialysis has been described as being the result of a combination of neoangiogenesis and fibrosis. Glucose, glucose degradation products, and the unphysiological pH of the dialysate solution contribute to these changes. Although newer solutions clearly perform better in terms of their biocompatibility in an in vitro setting and in animal models, the benefit of such solutions over older solutions in the clinical setting is so far unproven. The difficulties in showing a benefit of the newer, more biocompatible solutions in the clinical setting can be explained by the fact that other factors also affect the properties of the peritoneal membrane. These factors are often neglected in clinical studies, which results in unnoticed differences in case-mix and blurs the potential impact of the novel solutions. However, many of these factors are modifiable, and attention should be paid to them in clinical practice to maintain the integrity of the peritoneal membrane. This Review focuses on factors that potentially influence the integrity of the peritoneal membrane, other than those associated with the peritoneal dialysis fluid itself.
authors: Renal Division 0K12IA, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors: Anneleen
authors: A
authors: Pletinck
authors: Raymond
authors: R
authors: Vanholder
authors: Nic
authors: N
authors: Veys
authors: Wim
authors: W
authors: Van Biesen
mesh_terms: D001639:Bicarbonates / Q000627:therapeutic use; D001672:Biocompatible Materials; D015314:Dialysis Solutions / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010537:Peritoneum / Q000187:drug effects* / Q000503:physiopathology; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D014511:Uremia / Q000209:etiology / Q000517:prevention & control
chemical_list: D001639:Bicarbonates; D001672:Biocompatible Materials; D015314:Dialysis Solutions