Akira Onishi, Yoshiyuki Morishita, Shigeaki Muto and Eiji Kusano
Peritoneal fibrosis (PF) is a common morphological change in peritoneal dialysis (PD) patients. With the progression of PF, peritoneal membrane function is impaired, which leads to ultrafiltration failure. Furthermore, PF is an essential precursor condition for the development of encapsulating peritoneal sclerosis (EPS), which is the most serious complication of PD. Epithelial-mesenchymal transition (EMT) of peritoneal mesothelial cells (PMCs) plays a crucial role in PF. Transforming growth factor-?1 (TGF-?1) was thought to be the main regulator of EMT in PMCs. High glucose, hypertonicity, low pH, glucose degradation products and advanced glycation end-products in PD solution were suggested to induce TGF-?1 production. In addition, chronic inflammation mediated by infiltration of immune cells and peritoneal angiogenesis also play pivotal roles for the progression of PF.
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