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PD Membrane Damage High Glucose — ESENeph MCQ

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ModeratePeritoneal DialysisPD Membrane Damage High GlucoseESENeph

A 50-year-old man with CKD G5D on PD has been using 3.86% (hypertonic) glucose bags for most of his exchanges due to persistent fluid overload. His peritoneal membrane has changed from average to high transporter status over 3 years. His ultrafiltration has worsened. What has happened?

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Correct answer: E — Chronic exposure to high-glucose dialysate causes peritoneal membrane damage: neoangiogenesis (increased vascularity), fibrosis, and accelerated solute transport – leading to membrane failure and ultrafiltration loss

Chronic exposure to bioincompatible conventional glucose-based PD dialysate (particularly high-concentration glucose) causes progressive peritoneal membrane changes: (1) submesothelial fibrosis; (2) neoangiogenesis (increased peritoneal vascularity via VEGF upregulation from glucose degradation products); (3) vasculopathy; and (4) loss of mesothelial cell integrity. These changes increase solute transport rate (shift toward high transporter), causing rapid glucose absorption, loss of osmotic gradient, and ultrafiltration failure. Prevention includes minimising high-glucose bags, using Icodextrin for the long dwell, and using biocompatible PD solutions (low GDP, neutral pH).

Reference: ISPD 2020 – PD Solutions; Davies et al 2001 – Peritoneal Membrane Changes