The Peritoneal Membrane and Its Role in Peritoneal Dialysis.
This review summarizes the structure, function, and pathophysiology of the peritoneal membrane, emphasizing that a healthy membrane is essential for adequate ultrafiltration and that membrane dysfunction drives fluid overload and adverse outcomes in peritoneal dialysis.
Background
A healthy and functional peritoneal membrane is key to achieving sufficient ultrafiltration and restoring fluid balance in patients treated with peritoneal dialysis. Variability in membrane function at the start of treatment, or changes over time, influences dialysis prescription and clinical outcomes, and membrane dysfunction contributes to fluid overload and its associated complications.
Key recommendations
The review describes the molecular and genetic mechanisms of solute and water transport across the membrane, including the role of aquaporin water channels in crystalloid versus colloid osmosis, and the distinction between small pores, large pores, and aquaporin-1-mediated ultrasmall water pores. It explains why and how to assess membrane function using the peritoneal equilibration test and addresses the etiologies and specific management of membrane dysfunction.
Clinical implications
Understanding membrane structure and transport physiology supports individualized, patient-centered prescription, including measures to preserve membrane integrity and mitigate the higher mortality and technique-failure risk associated with a faster peritoneal solute transport rate. The review also highlights how genetic variation influences membrane function and outcomes, and identifies gaps in knowledge as targets for future research.
Category
Research
Source
Clin J Am Soc Nephrol
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