Peritoneal Sclerosis: A 'Sword of Democles' for Peritoneal Dialysis?

Sclerotic thickening of tissue is a common and perhaps universal response to recurrent irritation and inflammation. Take any organ in the human body, inflame it, and subsequently examine the reparative process, and it will involve an increased deposition of collagen tissue and result in sclerosis. Thus, it is not surprising that, in patients subjected to recurrent (and possibly continued) inflammation of the peritoneal cavity, sclerotic changes in the peritoneal membrane should occur. In a recent issue of theArchives(1980;140:1201-1203), Gandhi et al report that patients who have undergone long-term peritoneal dialysis and have suffered from recurrent peritonitis have grossly visible and subjectively alarming amounts of peritoneal sclerosis develop. As pointed out by these authors, there are multiple known ways to inflame the peritoneum in addition to infecting it. Peritoneal dialysate is extremely hypertonic 1 and acidic. 1,2 It may contain a variety of irritants ranging from talc 3 to