Peritoneal fibrosis - Future prevention strategies

Abstract

Peritoneal fibrosis is one of the most serious complications of peritoneal dialysis, and is characterized by the activation of peritoneal resident cells (mesothelial cells, endothelial cells, fibroblasts and macrophages), induction of pro-fibrotic peptides, accumulation and deposition of excess matrix proteins within the submesothelium, and vasculopathy of the peritoneal microvasculature. In order to provide novel therapeutic strategies that will allow us to preserve the structural and functional integrity of the peritoneum during peritoneal dialysis, it is essential to elucidate the mechanisms of peritoneal fibrosis. There is now compelling evidence to show that elevated glucose concentrations present in peritoneal dialysis fluids and its by-products play a pivotal role in the initiation of peritoneal fibrosis. This review will describe the pathogenesis of glucose-mediated peritoneal fibrosis, and highlight recent in vitro data that may one day be extended to clinical trials, offering effective treatment in the preservation of the structure of the peritoneum. Such strategies include the employment of alterative osmotic agents (amino acids or icodextrin), transforming growth factor-β1 antagonists, gene therapy, and pharmacological intervention.