**Meet the editor**

Dr. Abelardo Aguilera Peralta was born in Tegucigalpa, Honduras on June 3, 1967. He obtained the title of general practitioner in 1989 at the Facultad de Medicina de la Universidad Nacional Autónoma de Honduras, in Tegucigalpa. He studied Nephrology at the Hospital Ramón y Cajal, from Madrid, Spain (1991-1994) and obtained the title of Doctor (PhD) from the Universidad Autóno-

ma de Madrid (2007). He was also a Pre-doctoral fellow at the Nephrology Institute, Cardiff, Wales, UK (1999-2000). Currently Dr. Aguilera is a senior researcher for the Miguel Servet Program at the Hospital Universitario de la Princesa, Madrid, since 2007. Dr. Aguilera has also more than 100 scientific articles published mainly in international journals, among which the New Engl J Med, J Am Soc Nephrol, Lab Investigation, Plos One, etc. He has received more than 25 national and international awards, has a degree in Physics. He is a specialist in family medicine and a Reviewer and editor of several international journals.

Finally, his main research areas are epithelial-to-mesenchymal transition of mesothelial cells and peritoneal membrane failure, and disorders in appetite regulation on dialysis patients.

Contents

**Preface VII**

Zhen Su

**Section 1 The Peritoneal Catheter in Peritoneal Dialysis 1**

Rafael Selgas and Manuel López-Cabrera

Chapter 3 **Encapsulating Peritoneal Sclerosis 39**

Chapter 4 **Inflammation in Peritoneal Dialysis 55**

**Function in Peritoneal Dialysis 83** Betül Kalender and Necmi Eren

and Niko Braun

C.W. Tang

Chapter 1 **Peritoneal Dialysis Catheter Placement and Management 3**

**Section 2 Peritoneal Membrane Complication in Peritoneal Dialysis 19**

Chapter 2 **The Mesothelial to Mesenchymal Transition a Pathogenic and Therapeutic Key for Peritoneal Membrane Failure 21** Abelardo Aguilera, Jesús Loureiro, Guadalupe Gónzalez-Mateo,

**Section 3 Systemic Complications Associated to Peritoneal Dialysis 53**

Chapter 5 **The Association with Cardiovascular Events and Residual Renal**

Joerg Latus, Christoph Ulmer, Martin Kimmel, M. Dominik Alscher

Joseph C.K. Leung, Loretta Y. Y. Chan, Kar Neng Lai and Sydney

## Contents

**Preface XI**



Preface

cy, it also increased its complications.

The peritoneal dialysis (PD) is a kidney replacement therapy technique that has been growing in the last years. One reason for this growth is the freedom that the PD technique provides pa‐ tients allowing them a better social development. However, parallel to the increase in frequen‐

Cardiovascular and infectious diseases, malnutrition and peritoneal damage arising from inher‐ ent to PD process itself are still the leading causes of morbidity and mortality. Recently, there have been many advances in the understanding of the complications associated with PD and uremic state that suggests that the peritoneal cavity is a victim of the attacks produced by bioincompatible liquids, plastics, hemoperitoneum and infections and see victimizer because acti‐ vation of this cavity acts as a true organ releasing substances with systemic effects. These substances could induce systemic effects as inflammation, dyslipidemia, diabetes, hyperten‐ sion, accelerated atherosclerosis and malnutrition. Effectively, the hyperproduction and renal retention of pro-inflammatory cytokines is key for the initiation and maintenance of accelerated atherosclerosis, loss of renal function, bone renal diseases, protein malnutrition and other ure‐ mic complications. Furthermore, local effects of PD liquids that activate the immune system, the abdominal fat tissue, which is bathed by these PD liquids, the mesothelial cells and the oth‐ er components of the abdominal cavity, induce deterioration of the peritoneal membrane reach‐ ing anatomical and functional failure. Although considerable efforts to improve the biocompatibility of PD fluid has been made in the last years. It should be noted also that the changes undergone in the peritoneal and mesothelial-to-mesenchymal transition (MMT) offer new and novel therapeutic opportunities. MMT is regularly triggered by the action of glucose degradation products, low pH of the PD fluids, and other advance glycation end-products for‐ mation. These transdifferentiated mesothelial cells acquire migratory capacity, invade the sub‐ mesotelio where they produce high quantity of extracellular matrix components and high

number of sanguineous and lymphatic vessels (angiogenesis and lymphangiogenesis).

formation provided here. New therapeutic strategies are proposed.

This book provides an update on the emerging concepts in relation to new substances and mechanisms implicated in PD complications and attempts to organize the puzzle of these po‐ tentially active molecules. The authors have made a significant effort to update and summarize the relevance of each topic and especially to sort, in a logical and understandable way, the in‐

at Instituto de Investigación Sanitaria del Hospital Universitaria de la Princesa,

**Dr. Abelardo Aguilera Peralta (MD, Ph.D),**

senior researcher (Miguel Servet Program)

specialty in Nephrology,

Madrid, Spain
