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Front. Physiol. | doi: 10.3389/fphys.2018.01853

Biocompatible Peritoneal Dialysis – The Target Is Still Way Off

 Maria Bartosova1 and Claus P. Schmitt1*
  • 1University Hospital, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Germany

Peritoneal dialysis (PD) is a cost-effective, home based therapy for patients with end stage renal disease achieving similar outcome as compared to hemodialysis. Still, a minority of patients only receives PD. To a significant extend, this discrepancy is explained by major limitations regarding PD efficiency and sustainability. Due to highly unphysiological composition of PD fluids, the peritoneal membrane undergoes rapid morphological and long-term functional alterations which limit the treatment and contribute to adverse patient outcome. This review is focused on the peritoneal membrane ultrastructure and its transformation in patients with kidney disease and chronic PD, underlying molecular mechanisms and potential systemic sequelae. Current knowledge on the impact of conventional and second generation PD fluids is described; novel strategies and innovative PD fluid types are discussed.

Keywords: Peritoneum, Peritoneal Dialysis, Glucose, Glucose degradation products, biocompability, transformation, transport, Junctions

Received: 21 Sep 2018; Accepted: 07 Dec 2018.

Edited by:

Janusz Witowski, Poznan University of Medical Sciences, Poland

Reviewed by:

Ramon Paniagua, Instituto Mexicano del Seguro Social (IMSS), Mexico
MIGUEL PEREZ FONTAN, University of A Coruña, Spain  

Copyright: © 2018 Bartosova and Schmitt. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Claus P. Schmitt, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, University Hospital, Heidelberg, Germany, clauspeter.schmitt@med.uni-heidelberg.de