Problematic relevance of animal studies on peritoneal vascularization to the clinical practice of peritoneal dialysis

Abstract

Background

Increased vascularity of the peritoneal membrane contributes to the ultrafiltration dysfunction in peritoneal dialysis (PD), which is an important subject of research, including animal studies. In this study, we have examined how animal studies assessing peritoneal vascularization in the context of PD are designed, conducted, and reported.

Methods

Relevant original articles published in 1979–2024 were identified in PubMed® and assessed for completeness, transparence, and unbiased reporting.

Results

Animal studies analyzed were conducted primarily in normal rodents and were based on two basic experimental models (exposure to peritoneal dialysis fluid or chlorhexidine gluconate). In both cases, increased peritoneal vascularity was reported consistently, although to a varying degree. Studies in uremic animals were infrequent (20%), but suggested strongly that uremia itself increased peritoneal vascularity and was associated with decreased peritoneal ultrafiltration and increased peritoneal solute transport rates. Use of chlorhexidine accelerated membrane injury but did not lead to significant new insights. Pharmacological attempts to limit increased peritoneal vascularization demonstrated that such interventions were feasible at multiple levels. However, all these studies were limited by the choice of animals and drug doses, as well as by omissions in reporting key information.

Conclusions

This literature review found that there was considerable variability in the design, methodology, and reporting of animal studies investigating the effects of dialysis on peritoneal membrane vascularity. A framework to enhance their reporting, in line with the current ARRIVE guidelines, is needed. Abandoning the use of chlorhexidine in future animal studies on PD should be considered.