Molecular and Peritoneal Microvascular Changes Cause Peritoneal Membrane Dysfunction by Uremia-Related Mechanisms

Background Long-term peritoneal dialysis (PD) is associated with distinct peritoneal structural changes characterized by thickening of the sub-mesothelial cell layer, fibrosis and angiogenesis. These changes were assumed to be the cause for peritoneal membrane dysfunction and technique failure that was observed in some long-term PD patients. However, this assumption was refuted by the findings from animal models of chronic PD that showed the exact structural phenotype of the long-term PD, and yet a normal peritoneal function. This study was set to determine that the peritoneal microvascular and interstitial changes associated with long-term PD in rats produce peritoneal dysfunction by uremia related mechanisms. Our studies have demonstrated that acute exposure of the peritoneum to glucose-based PD solutions produces rapid and sustained visceral peritoneal microvascular vasodilation via the nitric oxide (NO) pathway. At present, there is no literature data on the reactivity of these peritoneal microvessels...