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REVIEW article

Front. Physiol.
Sec. Renal Physiology and Pathophysiology
Volume 15 - 2024 | doi: 10.3389/fphys.2024.1322493
This article is part of the Research Topic Advances and Insights in Peritoneal Dialysis: A Physiological Perspective View all 10 articles

Physiology of peritoneal dialysis; pathophysiology in long-term patients

Provisionally accepted
Raymond T. Krediet Raymond T. Krediet *
  • Academic Medical Center, Amsterdam, Netherlands

The final, formatted version of the article will be published soon.

    The microvascular wall of peritoneal tissues is the main barrier in solute and water transport in the initial phase of peritoneal dialysis (PD). Small solute transport is mainly by diffusion through inter-endothelial pores, as is hydrostatic fluid transport with dissolved solutes. Water is also transported through the intra-endothelial water channel aquaporin-1(AQP-1) by a glucose-induced crystalloid osmotic gradient (free water transport). In the current review the physiology of peritoneal transport will be discussed both during the first years of PD and after long-term treatment with emphasis on the peritoneal interstitial tissue and its role in free water transport. Attention will be paid to the role of glucose-induced pseudohypoxia causing both increased expression of fibrogenetic factors and of the glucose transporter GLUT-1. The former leads to peritoneal fibrosis, the latter to a reduced crystalloid osmotic gradient, explaining the decrease in free water transport as a cause of ultrafiltration failure. These phenomena strongly suggest that the extremely high dialysate glucose concentrations are the driving force of both morphologic and functional peritoneal alterations that may develop during long-term PD.

    Keywords: Peritoneal Dialysis, Pseudohypoxia, Glucose, GLUT-1, ultrafiltration failure, free water transportr, Peritoneal Fibrosis, Long-term PD

    Received: 16 Oct 2023; Accepted: 10 Jul 2024.

    Copyright: © 2024 Krediet. 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) or licensor 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: Raymond T. Krediet, Academic Medical Center, Amsterdam, Netherlands

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