Document Detail


Determinants of peritoneal membrane function over time.
MedLine Citation:
PMID:  21439431     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Changes to peritoneal membrane function over time result in the development of ultrafiltration failure in a proportion of PD patients and pose a risk for the rarer condition of encapsulating peritoneal sclerosis. These changes are characterized by an increase in the transport rate for small solutes owing to increased vascularity and/or peritoneal blood flow and in more severe cases a reduction in the osmotic conductance of the membrane that likely reflects progressive fibrosis. Both of these processes are preceded by exposure of the membrane to glucose when using conventional dialysis solutions, although this usually is necessitated and likely exacerbated by loss of residual renal function and recurrent peritonitis. Mediators of membrane injury and thus potential biomarkers include inflammatory cytokines, notably local interleukin-6 production, which also appears to determine solute transport characteristics at the start of peritoneal dialysis, local production of vascular endothelial growth factor, and transforming growth factor β-associated epithelial to mesenchymal transition of the mesothelium leading to membrane fibrosis. Low glucose degradation product solutions may ameliorate the mesothelial injury associated with high glucose exposure, but evidence that they prevent or delay changes in membrane function over time is lacking. In the meantime, avoidance of excessive glucose exposure, preservation of residual renal function, and prevention of peritonitis remain the most logical treatment strategies for this problem.
Authors:
Simon J Davies; Lily Mushahar; Zanzhe Yu; Mark Lambie
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Seminars in nephrology     Volume:  31     ISSN:  1558-4488     ISO Abbreviation:  Semin. Nephrol.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110298     Medline TA:  Semin Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  172-82     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Nephrology, University Hospital of North Staffordshire, Stoke on Trent, Staffordshire, United Kingdom; Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, United Kingdom.
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