Effects of inflammation and infection on peritoneal transport

Peritoneal dialysis (PD) allows solute and water transport. Adequate PD depends on a good function of the peritoneal membrane. Peritoneal morphological and functional alterations mostly develop with time on PD. Glucose based dialysis solutions, inflammation and infections are conceivable enemies for peritoneal integrity. In this thesis, the effects of potential enemies on the peritoneal membrane have been described. Furthermore, the experience with peritonitis in the AMC has been discussed with regard to important treatment changes over 32-years of clinical practice. Peritonitis is a manageable complication of PD. Peritonitis rates have improved significantly over the years because of several changes in PD treatment, but the need to change the initial antibiotic increased, because the most frequent cause of peritonitis, coagulase-negative Staphylococcus, showed a decreased susceptibility for the initial empiric antibiotic over time. On top of the natural course of peritoneal function, peritonitis episodes influenced to some extent the time-course of small solute and fluid transport. These modifications will increase the risk of overhydration, especially in patients without urine production. In contrast to the number or timing of the peritonitis episodes, severe peritonitis had a negative effect on the time-course of peritoneal transport. Patients who experienced frequent peritonitis episodes in the first three years of PD, had low dialysate IgG concentrations at the start of PD. This may lead to a lower opsonic activity, which is a risk factor for peritonitis. This thesis contributes to a better understanding of the causes and effects of peritoneal alterations, including consequences for prevention and treatment.