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Functional deterioration of the peritoneum as a dialyzing organ is a leading cause of peritoneal dialysis (PD) failure. The problem usually develops 2-4 years after the initiation of therapy (Davies et al., 1996; Struijk et al., 1994) and may affect as many as 50% of all PD patients (Kawaguchi et al., 1997). The alterations that develop in the peritoneal membrane over time include submesothelial thickening, fibrosis, angiogenesis, and vascular degeneration (Honda et al., 2008; Mateijsen et al., 1999; Williams et al., 2002; Williams et al., 2003). These changes are associated with an increase in peritoneal solute transport with resultant dissipation of the osmotic gradient and loss of ultrafiltration. Indeed, it has been estimated that up to 75% of patients with ultrafiltration failure will have increased vascular area (Heimburger et al., 1990; Ho-Dac-Pannekeet et al., 1997). Pathological angiogenesis not only increases vascular surface area of the peritoneum but is also a key step in the progression of fibrosis (Wynn, 2007). Therefore, it is essential to understand how PD environment impacts on peritoneal vasculature.

Angiogenic Activity of the Peritoneal Mesothelium: Implications for Peritoneal Dialysis