**3. Natural history of peritoneal membrane in CAPD**

The peritoneal fibrosis has two parts; fibrosis process itself and the inflammation which is promoted by the non-physiologic content of solutions and infections. In the fibrotic process, there is loss of mesothelial cells with fibroblastoid changes leading to mesothelial-to-mesenchymal transition mediated by TGF-ß (Transforming growth factor) and VEGF (Vascular endothelial growth factor) signaling pathways. The inflammation pathway is mediated by the IL-6 (Interleukin-6) and other chemokines. Both the pathways are interlinked to each other and will be potentiating each other.
