Clinical Causes of Inflammation in Peritoneal Dialysis Patients
Table 1
Summary of proposed mechanisms underlying clinical causes of inflammation in peritoneal dialysis patients and possible treatment options.
Clinical causes of inflammation
Proposed mechanism
Possible treatment options
Loss of residual renal function
(i) Impaired renal clearance of inflammatory cytokines (ii) Direct stimulation of cytokine generation by uraemic milieu (iii) Adverse effect of inflammation on residual renal function
Strategies to improve residual renal function, such as (i) avoidance of nephrotoxic agents or acute kidney injuries (ii) use of biocompatible PD solutions
Peritoneal dialysis: use of conventional peritoneal dialysis solutions
Use of biocompatible solutions characterised by neutral pH, low glucose degradation product content
Peritoneal dialysis catheters
Biofilm formation within the catheter lumen
Use of catheters resistant to biofilm formation
Peritoneal dialysis-related peritonitis
Induces acute inflammatory response
Peritonitis prevention strategies: (i) disconnect systems (twin-bag and Y-set) (ii) preoperative administration of intravenous antibiotics prior to PD catheter insertion
Peritoneal membrane dysfunction and endotoxemia
Bowel oedema from volume overload precipitating endotoxemia by translocation of macromolecules from gut