School of Medicine

Renal replacement therapy is a chronic incurable condition associated with significant morbidity and mortality and requires daily therapeutic intervention. While there remains no cure for renal deterioration and the number of available kidney donors is limited, chronic dialysis remains an essential daily life-saving treatment modality.

Treatment with peritoneal dialysis (PD) offers significant treatment, lifestyle, and quality of life advantages over hospital haemodialysis. In addition, it is a more cost-effective therapy. The “Achilles’ heel” of PD, however, remains the susceptibility to recurrent infection with detrimental effects on the process of dialysis through direct membrane damage, but also in more severe infection through significant morbidity and mortality.

Over the past decade there has been a shift in infection profiles towards more virulent infections and an increased prevalence of antibiotic resistance. This, together with the already unacceptable cure and relapse rates, and concomitant morbidity and mortality represent significant limitations to PD therapy.

As we approach the post-antibiotic era there is a clear need for novel therapies to fight infections by resistant strains and improve patient outcomes. If we are to limit the susceptibility to infection and the detrimental impact of prolonged inflammation on membrane longevity, we need to better understand the processes causing deleterious alterations to the peritoneal immune response.

The peritoneal cavity in PD serves as unique window to inflammatory scenarios that can be prospectively observed in vivo. It affords easy, continuous access to all relevant cellular and humoral players, and allows us to examine how treatment and infection modulate these processes. We know of no other experimental model that gives such direct insight into human immune responses in a similarly clinically relevant, convenient, non-invasive manner.