Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Coupling Osmotic Efficacy with Biocompatibility in Peritoneal Dialysis: A Stiff Challenge

Mario Bonomini
* ,
Valentina Masola
ORCID logo ,
Maria Pia Monaco
,
Vittorio Sirolli
,
Lorenzo Di Liberato
ORCID logo ,
Tommaso Prosdocimi
,
Arduino Arduini
Version 1 : Received: 15 February 2024 / Approved: 16 February 2024 / Online: 16 February 2024 (07:49:01 CET)

A peer-reviewed article of this Preprint also exists.

Bonomini, M.; Masola, V.; Monaco, M.P.; Sirolli, V.; Di Liberato, L.; Prosdocimi, T.; Arduini, A. Coupling Osmotic Efficacy with Biocompatibility in Peritoneal Dialysis: A Stiff Challenge. Int. J. Mol. Sci. 2024, 25, 3532. Bonomini, M.; Masola, V.; Monaco, M.P.; Sirolli, V.; Di Liberato, L.; Prosdocimi, T.; Arduini, A. Coupling Osmotic Efficacy with Biocompatibility in Peritoneal Dialysis: A Stiff Challenge. Int. J. Mol. Sci. 2024, 25, 3532.

Abstract

Peritoneal dialysis (PD) is a home-based efficacious modality for replacement of renal function in end-stage kidney failure patients but is still under-prescribed. A major limitation is the durability of the dialytic technique. Continuous exposure of the peritoneum to bioincompatible conventional glucose-based solutions is thought to be the main cause of long-term morpho-functional peritoneal changes eventually resulting in ultrafiltration failure. Poor PD solution biocompatibility is primarily related to the high glucose content, which is not only detrimental to the peritoneal membrane but has many potential metabolic side effects. To improve the clinical outcome and prolong the survival of the treatment, PD-related bioincompatibility urgently needs to be overcome. However, combining dialytic and osmotic efficacy with a satisfactory biocompatible profile proves quite difficult. New approaches targeting the composition of the PD solution include replacement of glucose with other osmotic agents and the addition of cytoprotective or osmo-metabolic compounds. Other strategies include infusion of mesenchymal cells or the administration of orally active agents. In the present article we review the current evidence on efforts to improve the biocompatible and functional performance of PD, focusing on studies performed in vivo (animal models of PD, human subjects on PD).

Keywords

peritoneal dialysis; peritoneum; biocompatibility; peritoneal dialysis solution; ultrafiltration; peritoneal fibrosis; metabolism

Subject

Medicine and Pharmacology, Urology and Nephrology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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