{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:09:55Z","timestamp":1793300995556,"version":"4.5.0"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>\n                    Ultrafiltration is essential in peritoneal dialysis (PD) for maintenance of euvolemia, making ultrafiltration insufficiency\u2014preferably called ultrafiltration failure\u2014an important complication. The mechanisms of ultrafiltration and ultrafiltration failure are more complex than generally assumed, especially after long-term treatment. Initially, ultrafiltration failure is mainly explained by a large number of perfused peritoneal microvessels, leading to a rapid decline of the crystalloid osmotic gradient, thereby decreasing aquaporin-mediated free water transport. The contribution of peritoneal interstitial tissue to ultrafiltration failure is limited during the first few years of PD, but becomes more important in long-term PD due to the development of interstitial fibrosis, which mainly consists of myofibroblasts. A dual hypothesis has been developed to explain why the continuous exposure of peritoneal tissues to the extremely high dialysate glucose concentrations causes progressive ultrafiltration decline. First, glucose absorption causes an increase of the intracellular NADH\/NAD\n                    <jats:sup>+<\/jats:sup>\n                    ratio, also called pseudohypoxia. Intracellular hypoxia stimulates myofibroblasts to produce profibrotic and angiogenetic factors, and the glucose transporter GLUT-1. Second, the increased GLUT-1 expression by myofibroblasts increases glucose uptake in these cells, leading to a reduction of the osmotic gradient for ultrafiltration. Reduction of peritoneal glucose exposure to prevent this vicious circle is essential for high-quality, long-term PD.\n                  <\/jats:p>","DOI":"10.1681\/asn.2021010080","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T14:05:11Z","timestamp":1627481111000},"page":"2408-2415","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":53,"title":["Acquired Decline in Ultrafiltration in Peritoneal Dialysis: The Role of Glucose"],"prefix":"10.1681","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-8507","authenticated-orcid":false,"given":"Raymond T.","family":"Krediet","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,10]]},"reference":[{"key":"B1-20240826","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1177\/089686080002004S02","article-title":"Evaluation and management of ultrafiltration problems in peritoneal dialysis","volume":"20","author":"Mujais","year":"2000","journal-title":"Perit Dial Int"},{"key":"B2-20240826","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1038\/sj.ki.5000183","article-title":"Peritoneal transport assessment by peritoneal equilibration test with 3.86% glucose: a long-term prospective evaluation","volume":"69","author":"La Milia","year":"2006","journal-title":"Kidney Int"},{"key":"B3-20240826","doi-asserted-by":"crossref","first-page":"e0158741","DOI":"10.1371\/journal.pone.0158741","article-title":"Overhydration is a strong predictor of mortality in peritoneal dialysis patients \u2013 independently of cardiac failure","volume":"11","author":"Jotterand Drepper","year":"2016","journal-title":"PLoS One"},{"key":"B4-20240826","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1177\/089686080002004S03","article-title":"Pathophysiology of peritoneal membrane failure","volume":"20","author":"Krediet","year":"2000","journal-title":"Perit Dial Int"},{"key":"B5-20240826","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1177\/089686089301302S09","article-title":"A three-pore model of peritoneal transport","volume":"13","author":"Rippe","year":"1993","journal-title":"Perit Dial Int"},{"key":"B6-20240826","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1038\/sj.ki.5001861","article-title":"Analysis of fluid transport pathways and their determinants in peritoneal dialysis patients with ultrafiltration failure","volume":"70","author":"Parikova","year":"2006","journal-title":"Kidney Int"},{"key":"B8-20240826","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1038\/sj.ki.5000285","article-title":"Aquaporin-1 plays an essential role in water permeability and ultrafiltration during peritoneal dialysis","volume":"69","author":"Ni","year":"2006","journal-title":"Kidney Int"},{"key":"B9-20240826","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1177\/089686089601601S08","article-title":"Demonstration of aquaporin-CHIP in peritoneal tissue of uremic and CAPD patients","volume":"16","author":"Pannekeet","year":"1996","journal-title":"Perit Dial Int"},{"key":"B10-20240826","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/089686089501500109","article-title":"Does impaired transcellular water transport contribute to net ultrafiltration failure during CAPD?","volume":"15","author":"Monquil","year":"1995","journal-title":"Perit Dial Int"},{"key":"B11-20240826","first-page":"F861","article-title":"Osmotic barrier of the parietal peritoneum","volume":"267","author":"Flessner","year":"1994","journal-title":"Am J Physiol"},{"key":"B12-20240826","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/ndt\/13.1.146","article-title":"Day-to-day variability of fluid and solute transport in upright and recumbent position during CAPD","volume":"13","author":"Imholz","year":"1998","journal-title":"Nephrol Dial Transplant"},{"key":"B13-20240826","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1093\/ndt\/gfl745","article-title":"Intraperitoneal pressure in PD patients: Relationship to intraperitoneal volume, body size and PD-related complications","volume":"22","author":"Dejardin","year":"2007","journal-title":"Nephrol Dial Transplant"},{"key":"B14-20240826","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/physrev.1993.73.1.1","article-title":"Interstitial-lymphatic mechanisms in the control of extracellular fluid volume","volume":"73","author":"Aukland","year":"1993","journal-title":"Physiol Rev"},{"key":"B15-20240826","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S0272-6386(12)80814-6","article-title":"Functional longevity of the human peritoneum: How long is continuous peritoneal dialysis possible? 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