Novel Aspects of the Immune Response Involved in the Peritoneal Damage in Chronic Kidney Disease Patients under Dialysis

Abstract

Chronic kidney disease (CKD) incidence is growing worldwide, with a significant percentage of CKD patients reaching end-stage renal disease (ESRD) and requiring kidney replacement therapies (KRT). Peritoneal dialysis (PD) is a convenient KRT presenting benefices as home therapy. In PD patients, the peritoneum is chronically exposed to PD fluids containing supraphysiologic concentrations of glucose or other osmotic agents, leading to the activation of cellular and molecular processes of damage, including inflammation and fibrosis. Importantly, peritonitis episodes enhance peritoneum inflammation status and accelerate peritoneal injury. Here, we review the role of immune cells in the damage of the peritoneal membrane (PM) by repeated exposure to PD fluids during KRT as well as by bacterial or viral infections. We also discuss the anti-inflammatory properties of current clinical treatments of CKD patients in KRT and their potential effect on preserving PM integrity. Finally, given the current importance of coronavirus disease 2019 (COVID-19) disease, we also analyze here the implications of this disease in CKD and KRT.

Intercellular communication in peritoneal dialysis

“…Th17 cells predominantly release cytokines of the IL-17 family, particularly IL-17A. Multiple lines of experimental evidence underscore the involvement of Th17/IL17A in both acute peritoneal damage and chronic inflammation of the peritoneal membrane ( Trionfetti et al, 2023 ). Spontaneous and cytokine-mediated Th17 polarization is enhanced by PD-range glucose concentrations.…”

Mechanisms of mesothelial cell response to viral infections: HDAC1-3 inhibition blocks poly(I:C)-induced type I interferon response and modulates the mesenchymal/inflammatory phenotype

“…MCs are leading players in the development of serosal inflammation and fibrosis during infections because they synthesize components of the extracellular matrix protein (ECM) such as fibronectin-1 (FN-1), collagens, as well as mediators of inflammation such as prostaglandins and prostacyclin, cytokines, and chemokines ( Strippoli et al., 2016 ; Trionfetti et al., 2023b ). Invading microorganisms induce the first phase of peritoneal inflammation characterized by the resident macrophages and MCs, whose cross-talk plays a role in the amplification of the inflammatory response through the production of proinflammatory cytokines ( Jonjic et al., 1992 ; Topley et al., 1993a ; Topley et al., 1993b ; Terri et al., 2021 ).…”

Diagnostic Accuracy of MMP-8 and IL-6-Based Point-of-Care Testing to Detect Peritoneal Dialysis-Related Peritonitis: A Single-Center Experience

“…The nature of peritoneal dialysis of the repeated infusion of dialysis fluid in the peritoneal cavity, which contains high concentrations of glucose or other osmotic agents, triggers cellular and molecular processes, leading to inflammation and fibrosis of the peritoneal membrane. Significantly, peritonitis episodes enhance the inflammatory status and accelerate the progression of peritoneal injury [ 7 ]. The reported survival of the PD modality is approximately 50% in the first 3 to 5 years, with fewer than 4% of patients maintaining PD for over 7 years [ 8 ].…”