Wontanatawatot Wassawon, Eiam-Ong Somchai, Leelahavanichkul Asada, Kanjanabuch Talerngsak
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2011 Sep;94 Suppl 4:S175-83.
Peritoneal membrane changes over time in long-term peritoneal dialysis (PD) patients lead to dialysis failure and increased morbidity as well as mortality. Bio-incompatable PD solution, peritonitis, and uremia are hypothesized in causing membrane damage. Fibrous organization and angiogenesis of peritoneum are crucial morphological alterations which can diminish the efficacy of exchange and cause ultrafiltration failure. Pathophysiologic mechanisms of membrane damage have been extensively studied to innovate therapeutic strategies. One of the potential mechanisms is a presence of local renin-angiotensin-aldosterone system (RAAS) by which injured peritoneal mesothelial cell-derived angiotensin-II (AII) causes activations in TGF-beta, VEGF expression, and epithelial-to-mesenchymal transition (EMT) which contributes to extracellular matrix accumulation and neoangiogenesis in submesothelial tissues. Clinical evidence of RAAS blockade on human peritoneal membrane remains under investigation and is still inconclusive but relevant data seem to demonstrate its benefit on membrane preservation. Longitudinal effect of RAAS blockade on membrane structural, functional, and clinical relationships and strategies to use angiotensin converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), aldosterone antagonist, and direct renin inhibitor are an interesting field to be explored.
长期腹膜透析（PD）患者的腹膜随时间变化会导致透析失败，并增加发病率和死亡率。生物不相容的腹膜透析液、腹膜炎和尿毒症被认为是导致腹膜损伤的原因。腹膜的纤维组织形成和血管生成是关键的形态学改变，可降低交换效率并导致超滤失败。为创新治疗策略，人们对腹膜损伤的病理生理机制进行了广泛研究。一种潜在机制是局部肾素-血管紧张素-醛固酮系统（RAAS）的存在，受损的腹膜间皮细胞衍生的血管紧张素-II（AII）通过该系统导致转化生长因子-β（TGF-β）激活、血管内皮生长因子（VEGF）表达以及上皮-间质转化（EMT），这有助于细胞外基质在间皮下组织中的积累和新血管生成。RAAS阻断对人体腹膜作用的临床证据仍在研究中，尚无定论，但相关数据似乎表明其对腹膜有保护作用。RAAS阻断对腹膜结构、功能和临床关系的纵向影响以及使用血管紧张素转换酶抑制剂（ACEI）、血管紧张素II受体阻滞剂（ARB）、醛固酮拮抗剂和直接肾素抑制剂的策略是一个有待探索的有趣领域。
