The Durability of the Peritoneal Membrane

Abstract

Severe membrane functional limitations with time on peritoneal dialysis are infrequently reported. Occasional reports where most patients were affected by peritoneal functional loss are in conflict with the good preservation of function reported by others. Such endemic distribution of structural and functional deterioration of the peritoneum should facilitate the search for etiologic factors. In the present state of ignorance it seems wise to treat infectious peritonitis promptly and aggressively, to support research in the area of membrane solution interaction and to carefully monitor the effects of chronic peritoneal dialysis on the peritoneal membrane.The most important determinant of the success of peritoneal dialysis in providing adequate therapy for chronic renal failure is the durability of the peritoneal membrane. Dobbie et al (I) have clearly stated the magnitude and severity of the problem in the following passage: “In view of the fact that most renal dialysis centres throughout the world are now embarking on a relatively new form of treatment for chronic renal failure -continuous ambulatory peritoneal dialysis, it is perhaps ironic that so little is known structurally of the tissue on which depends a life maintaining procedure and on which so many aspirations are now based.” Our ignorance of the peritoneal architecture is surpassed only by our poor understanding of the relationships between functional and structural changes.From the functional point of view, the peritoneal membrane includes the mesothelium which covers its free surface, the peritoneal interstitium, probably composed of an aqueous network bathing gels of mucosaccharides and collagen, and the microcirculation. Extensive research has been recently initiated to study the role of each of these components in transperitoneal transport and ultrafiltration and the effect of chemical and mechanical injury on the peritoneal membrane (1,2). The interest in investigating the factors responsible for altered states of solute and water transport during peritoneal dialysis has been stimulated by alanning reports suggesting functional deterioration of the peritoneal membrane system during chronic dialysis (3,4).