Mechanisms of peritoneal membrane injury. Factors related to PD solutions (increased glucose exposure and glucose degradation products (GDPs)) along with patient specific factors (peritonitis, inflammation, uremia, and genetic predisposition) are responsible for injury to the peritoneal membrane. Transforming growth factor beta (TGFB) is a central player in translating the injury signal to changes in the tissue. Inflammation is mediated by interleukin (IL) 6. GDPs induce advanced glycation end-products (AGEs) that can bind to the receptor for AGE (RAGE) to directly induce fibrosis. Angiogenesis is mediated by vascular endothelial growth factor (VEGF) and hypoxia.