New insights in the molecular mechanisms regulating peritoneal permeability

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Abstract
Peritoneal dialysis (PD) is used in approximately 15% of dialysis patients worldwide. With the reduction of acute peritonitis, the major problem associated with PD is now the high incidence of ultrafiltration (UF) failure, which can affect up to 50% of PD patients treated for more than 6 years [1]. Cross‐sectional and longitudinal studies have shown that peritoneal permeability for small solutes increases with time on PD, which induces a faster absorption of glucose, an early dissipation of the osmotic gradient and, eventually, UF failure [1,2]. The relevance of these modifications is illustrated by the fact that high peritoneal membrane (PM) permeability is a significant risk factor, predicting both technical failure and death in PD patients [3]. In this commentary, we will discuss how recent structural, functional and molecular data provide new insights in our understanding of the modifications of the PM in long‐term PD.