Peritoneal Inflammation and High Transport Status

Current US average annual growth of peritoneal dialysis (PD) is reported to be around 6 to 11% (1). There are wide variations in the utilization of PD in different countries. Similarly, there are wide variations in technique survival among various centers. If death and transplantation are excluded, infectious complications have been the most common reason for transfer out of PD. Over the past two decades, with improved technology and connectology systems, there has been a significant reduction in the rate of infectious complications. Centers with longer PD experience report PD-associated peritonitis rates on an average close to one episode for every six to seven patient years. In parallel, there has been increasing recognition of the importance of adequacy and ultrafiltration capacity. New adequacy guidelines now include, in addition to targets for solute clearances, ultrafiltration capacity recognition and BP control recommendations. There is now an acute awareness of the importance of peritoneal membrane transport characteristics in achieving favorable long-term morbidity and mortality. Factors that determine peritoneal membrane function in an individual are confounded by the coexistence of chronic inflammation due to uremia or other diseases, malnutrition, obesity, advanced cardiovascular diseases with hyperlipidemic state, diabetes, old age, ethnicity, and duration of PD. Recently, high peritoneal transport status in incident PD patients in particular has received increased attention due to poor outcome in some of them. It is as yet unclear what determines such a status in new patients starting PD. Interestingly, some of these high transporters have poor outcome and others do as well as other PD patients. Those with poor outcomes are recognized by the higher prevalence of markers of inflammation, malnourishment, and/or hypoalbuminemia. Studies to address these issues have been inconclusive and often are anecdotal experiences and based on small population studies.Peritoneal membrane permeability varies widely among individuals and …