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ENDOTHELIAL GLYCOCALYX AND THE PERITONEAL BARRIER

Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA

Correspondence to: M.F. Flessner, Department of Medicine/Nephrology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216-4505 USA. mflessner{at}medicine.umsmed.edu

Recent advances in the study of the microcirculation have demonstrated the critical role of the endothelial glycocalyx in transcapillary transport from the plasma to the tissue interstitium. Since the capillary wall represents the initial resistance to solute transfer from the plasma through the tissue to the dialysate, the glycocalyx is potentially of major importance to peritoneal dialysis. Inadvertently removed in early histological studies, this thin, delicate layer of glycosaminoglycans and proteoglycans is now recognized as a primary barrier in transendothelial solute and water transport. Subperitoneal endothelia are exposed to inflammation, angiogenesis, and hyperglycemia, which have been shown to affect the layer by increasing permeability. This entity permits new hypotheses concerning the factors that influence the transport characteristics of peritoneal dialysis patients and provides new avenues of basic research into the fundamental mechanisms of alteration of the peritoneal barrier.

KEY WORDS: Transport; microcirculation; peritoneum.

Received 15 August 2007; accepted 7 November 2007.

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