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	(i) Cumulative peritoneal membrane injury; (ii) Glucose degradation product mediated nephrotoxicity	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	Improvement in fluid status